Provider Demographics
NPI:1912893322
Name:WEBSTER URGENT CARE CALEDONIA LLC
Entity type:Organization
Organization Name:WEBSTER URGENT CARE CALEDONIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:GARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:662-418-9552
Mailing Address - Street 1:39 SOUTH STREET
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MS
Mailing Address - Zip Code:39740-8590
Mailing Address - Country:US
Mailing Address - Phone:662-356-1560
Mailing Address - Fax:662-356-1560
Practice Address - Street 1:39 SOUTH STREET
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MS
Practice Address - Zip Code:39740
Practice Address - Country:US
Practice Address - Phone:662-356-1560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-13
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS200020548Medicaid