| |
903 Mississippi Dr Tupelo MS 38804-0928 | |
(662) 377-4652 | |
(662) 377-4656 |
Full Name | |
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Speciality | Family Medicine |
Location | 903 Mississippi Dr, Tupelo, Mississippi |
Authorized Official Name and Position | Bruce Toppin (CORPORATE SECRETARY) |
Authorized Official Contact | 6623774229 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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808 Varsity Dr Tupelo MS 38801-4613 Ph: (662) 377-2774 | 903 Mississippi Dr Tupelo MS 38804-0928 Ph: (662) 377-4652 |
NPI Number | 1811006729 |
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Provider Enumeration Date | 08/30/2006 |
Last Update Date | 01/20/2025 |
Identifier | Type | State | Issuer |
---|---|---|---|
1811006729 | NPI | - | NPPES |
009014744 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
Pontotoc Health Providers Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 808 Varsity Dr, Tupelo, MS 38801 Phone: 662-377-2386 Fax: 662-377-2057 | |
Grant Family Medical Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 805 Varsity Dr, Tupelo, MS 38801 Phone: 484-252-6707 | |
North Mississippi Medical Clinics Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 808 Varsity Dr, Tupelo, MS 38801 Phone: 662-377-4685 Fax: 662-377-2057 | |