Organization
WESTSIDE FAMILY MEDICAL CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT LARRY TUCKER NP (CEO)
(662) 375-9810
Entity
Organization
Contact information
Practice address
2372 MS HIGHWAY 49 EAST, SUMNER, MS 38957
(662) 375-9310
(662) 375-9311
Mailing address
2372 HIGHWAY 49 EAST, SUMNER, MS 38957
(662) 375-9310
(662) 375-9311
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
R853452
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0123085
—
MS
Enumeration date
01/14/2013
Last updated
04/02/2013
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