Organization
EAST MAIN FAMILY MEDICAL CLINIC LLC
Active
Other names
Acute Care Family Medical Clinic of Verona
Organization subpart
No
Provider details
NPI number
Authorized official
RODNEY BRIAN RODGERS FNP (OWNER/NURSE PRACTITIONER)
(662) 350-3550
Entity
Organization
Contact information
Practice address
1424 E MAIN ST, TUPELO, MS 38804-2956
(662) 350-3550
(662) 842-3061
Mailing address
5024 RAYMOND AVE, TUPELO, MS 38801-8671
(662) 432-0782
(662) 842-3061
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R853214
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003300815
COMMERCIAL, BCBS
MS
05
—
1003300815
—
MS
Enumeration date
06/15/2018
Last updated
09/08/2020
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