NPIMap

Organization Active NPI

Westside Family Medical Clinic PLLC

  • Primary Care Clinic/Center
  • Sumner, MS
National Provider Identifier
1811234636
Registry record updated Apr 2, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
R853452 Issued in MS
Legal business name
WESTSIDE FAMILY MEDICAL CLINIC PLLC
Practice address
2372 Ms Highway 49 East
Sumner, MS 38957
Phone
(662) 375-9310
Fax
(662) 375-9311
NPI assigned
Jan 14, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Robert Larry Tucker, NP
Title
Ceo
Phone
(662) 375-9810

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X R853452 MS Primary

Addresses

Primary practice location

2372 Ms Highway 49 East
Sumner, MS 38957

Mailing address

2372 Highway 49 East
Sumner, MS 38957
Phone (662) 375-9310

Other identifiers 1

IdentifierTypeStateIssuer
0123085MedicaidMS

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1358121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364860800000",
    "number": "1811234636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2372 HIGHWAY 49 EAST",
            "city": "SUMNER",
            "state": "MS",
            "postal_code": "38957",
            "telephone_number": "662-375-9310",
            "fax_number": "662-375-9311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2372 MS HIGHWAY 49 EAST",
            "city": "SUMNER",
            "state": "MS",
            "postal_code": "38957",
            "telephone_number": "662-375-9310",
            "fax_number": "662-375-9311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTSIDE FAMILY MEDICAL CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-14",
        "last_updated": "2013-04-02",
        "status": "A",
        "authorized_official_last_name": "TUCKER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "LARRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "662-375-9810",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MS",
            "license": "R853452",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0123085",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sumner, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.