WESTSIDE FAMILY MEDICAL CLINIC PLLC (NPI# 1811234636) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811234636 |
| Entity Type | Organization |
| Organization Name | WESTSIDE FAMILY MEDICAL CLINIC PLLC |
| Practice Address |
2372 Ms Highway 49 East Sumner MS 38957 |
| Mailing Address |
2372 Highway 49 East Sumner MS 38957 |
| Practice Telephone | 6623759310 |
| Practice Fax Number | 6623759311 |
| Mailing Telephone | 6623759310 |
| Mailing Fax Number | 6623759311 |
| Enumeration Date | 2013-01-14 |
| Last Update Date | 2013-04-02 |
| Authorized Official Name | ROBERT LARRY TUCKER (CEO) |
| Authorized Official Telephone | 6623759810 |
| Authorized Official Credential | NP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
R853452 | MS | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 0123085 | 05 |
| Street Address |
2372 MS HIGHWAY 49 EAST |
| City | SUMNER |
| State | MS |
| Zip Code | 38957 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073113304 | Tasha Rucker | Nurse Practitioner | 2372 Us49-e, Sumner, MS 38957 | 2020-10-27 |
| 1376181990 | Cassidy Bayou Medical Clinic | Family Medicine | 2372 Us 49-e, Sumner, MS 38957 | 2019-12-13 |
| 1386180610 | Sonja Pennington | Nurse Practitioner | 2372 Us-49e Unit 240, Sumner, MS 38957 | 2017-01-10 |
| 1306966502 | Court Square Rural Health Clinic | Nurse Practitioner | 406 East Court St., Sumner, MS 38957 | 2007-03-30 |
| 1043212996 | Aaron E Henry Community Health | Clinic/Center | Friendship Rd, Sumner, MS 38957 | 2005-08-11 |
| 1356555080 | Hudson Sumner Drugs | Pharmacy | 108 N Court, Sumner, MS 38957 | 2007-05-10 |
| 1023428703 | Mississippi State Department of Health | Public Health or Welfare | 208 Wilson Street, Sumner, MS 38957-0000 | 2014-05-02 |
| 1952473571 | W & D Pharmacy Inc | Pharmacy | 110 Court Square, Sumner, MS 38957-0217 | 2006-11-15 |
| 1316040850 | Robert L Tucker | Nurse Practitioner | 2372 Hwy 49 East, Sumner, MS 38957-0250 | 2006-09-07 |
| 1275616831 | Ewell Spencer Hudson | Pharmacist | 108 N Court, Sumner, MS 38957-0526 | 2006-10-24 |
| Find all providers in zip 38957 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
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| 1720640899 | Home In The Woods Healthcare Clinic, LLC | Clinic/Center | 6572 County Road 514, Itta Bena, MS 38941-2746 | 2019-06-28 |
| 1366003436 | Blackwell's Family Medicine LLC | Clinic/Center | 107 Ball Ave, Tylertown, MS 39667-2101 | 2019-06-27 |
| 1710545488 | Primary and Behavioral Healthcare Services, Pa | Clinic/Center | 717 E. Fortification St., Jackson, MS 39202-2402 | 2019-05-29 |
| 1720559354 | Golden Years Geriatrics Inc. | Clinic/Center | 1233 County Road 108, New Albany, MS 38652-9787 | 2018-12-07 |
| 1316421373 | Children's International, LLC | Clinic/Center | 2003 Wildwood Rd, Picayune, MS 39466-2178 | 2018-09-17 |
| 1124505912 | Thaxton Family Medical Clinic LLC | Clinic/Center | 11145 Highway 6 W, Thaxton, MS 38871-9024 | 2018-07-24 |
| 1316439615 | Quad/med, LLC | Clinic/Center | 1000 Jere St. Pe' Hwy, C/o Ingalls Main Substation, 1st Floor, Pascagoula, MS 39567 | 2018-06-01 |
| 1194215681 | Brooks Medical Clinic | Clinic/Center | 2113 South Tate Street, Corinth, MS 38834 | 2018-05-10 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.