Provider Demographics
NPI:1154110575
Name:TIPLERSVILLE FAMILY MEDICAL CLINIC
Entity type:Organization
Organization Name:TIPLERSVILLE FAMILY MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEAVENER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:662-672-7527
Mailing Address - Street 1:2820 COUNTY ROAD 301
Mailing Address - Street 2:
Mailing Address - City:FALKNER
Mailing Address - State:MS
Mailing Address - Zip Code:38629-9321
Mailing Address - Country:US
Mailing Address - Phone:662-882-3635
Mailing Address - Fax:
Practice Address - Street 1:24111 HIGHWAY 15
Practice Address - Street 2:
Practice Address - City:TIPLERSVILLE
Practice Address - State:MS
Practice Address - Zip Code:38674
Practice Address - Country:US
Practice Address - Phone:662-672-7527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care