Organization
WESTSIDE FAMILY MEDICAL CLINIC OF TUPELO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NEIL VICKERS (OWNER)
(813) 712-9638
Entity
Organization
Contact information
Practice address
65 S THOMAS ST, TUPELO, MS 38801-4352
(813) 712-9638
Mailing address
65 S THOMAS ST, TUPELO, MS 38801-4352
(813) 712-9638
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/09/2015
Last updated
10/09/2015
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