Provider Demographics
NPI:1699236497
Name:WEBSTER FAMILY PRACTICE
Entity type:Organization
Organization Name:WEBSTER FAMILY PRACTICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:GARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-634-3089
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:MATHISTON
Mailing Address - State:MS
Mailing Address - Zip Code:39752-0190
Mailing Address - Country:US
Mailing Address - Phone:662-634-3089
Mailing Address - Fax:662-634-3063
Practice Address - Street 1:24849 MS HIGHWAY 15
Practice Address - Street 2:
Practice Address - City:MATHISTON
Practice Address - State:MS
Practice Address - Zip Code:39752-6900
Practice Address - Country:US
Practice Address - Phone:662-634-3089
Practice Address - Fax:662-634-3063
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEBSTER URGENT CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-26
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1122955OtherFICTITIOUS NAME