| Westside Family Medical Clinic Pllc | |
|
2372 Ms Highway 49 East Sumner MS 38957 | |
| (662) 375-9310 | |
| (662) 375-9311 |
| Full Name | Westside Family Medical Clinic Pllc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 2372 Ms Highway 49 East, Sumner, Mississippi |
| Authorized Official Name and Position | Robert Larry Tucker (CEO) |
| Authorized Official Contact | 6623759810 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Westside Family Medical Clinic Pllc 2372 Highway 49 East Sumner MS 38957 Ph: (662) 375-9310 | Westside Family Medical Clinic Pllc 2372 Ms Highway 49 East Sumner MS 38957 Ph: (662) 375-9310 |
| NPI Number | 1811234636 |
|---|---|
| Provider Enumeration Date | 01/14/2013 |
| Last Update Date | 04/02/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811234636 | NPI | - | NPPES |
| 0123085 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | R853452 (Mississippi) | Primary |
Tallachatchie School Based Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: Friendship Rd, Sumner, MS 38957 Phone: 662-375-8818 Fax: 662-375-8646 | |
Cassidy Bayou Medical Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2372 Us 49-e, Sumner, MS 38957 Phone: 662-375-9310 | |
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