NPIMap

Organization Active NPI

Alliance Healthcare System, Inc

  • Psychiatric Hospital
  • Holly Springs, MS
National Provider Identifier
1912182197
Registry record updated Apr 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
License
25S012 Issued in MS
Legal business name
ALLIANCE HEALTHCARE SYSTEM, INC
Practice address
1430 Highway 4 E
Holly Springs, MS 38635-2140
Phone
(662) 252-1212
NPI assigned
Jan 7, 2008
Last updated
Apr 8, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
ALLIANCE HEALTHCARE SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 8, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Perry E Williams Sr.
Title
Administrator/Ceo
Phone
(662) 252-1212

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X 25S012 MS Primary

Addresses

Primary practice location

1430 Highway 4 E
Holly Springs, MS 38635-2140

Mailing address

1430 Highway 4 E
Holly Springs, MS 38635-2140
Phone (662) 252-1212

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240524001944 MS Part A Provider - Hospital 2961489547 Practice locations: Holly Springs, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1912182197. Details of each certification follow.

Hospital certification: CCN 25S174

Legal name
ALLIANCE HEALTHCARE SYSTEM, INC
Organization structure
CorporationProprietary
Incorporated
Feb 1, 1989 in MS
Enrollment address
1430 Highway 4 E
Holly Springs, MS 38635-2140
Hospital Psychiatric Unit
Hospital subgroups
Acute care, Swing-bed approved, Psychiatric unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Part of
Darryl L Wilson MD

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Regina Williams Individual Corporate Director Nov 1, 1999
Kenneth Williams Individual 5% Or Greater Direct Ownership Interest Nov 1, 1999 100%
W-2 Managing Employee Nov 1, 1999 100%
Ethel Thompson Individual Corporate Director Nov 1, 1999

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1199664000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207612800000",
    "number": "1912182197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1430 HIGHWAY 4 E",
            "city": "HOLLY SPRINGS",
            "state": "MS",
            "postal_code": "386352140",
            "telephone_number": "662-252-1212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 HIGHWAY 4 E",
            "city": "HOLLY SPRINGS",
            "state": "MS",
            "postal_code": "386352140",
            "telephone_number": "662-252-1212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLIANCE HEALTHCARE SYSTEM, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ALLIANCE HEALTHCARE SYSTEM",
        "enumeration_date": "2008-01-07",
        "last_updated": "2008-04-08",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "PERRY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "ADMINISTRATOR/CEO",
        "authorized_official_telephone_number": "662-252-1212",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr."
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "MS",
            "license": "25S012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Holly Springs, MS

Sources for this page

Verify at the official NPI Registry.