| Family Medicine Residency Center | |
|
1665 S Green St Tupelo MS 38804-6556 | |
| (662) 377-2189 | |
| (662) 377-2263 |
| Full Name | Family Medicine Residency Center |
|---|---|
| Speciality | Family Medicine |
| Location | 1665 S Green St, Tupelo, Mississippi |
| Authorized Official Name and Position | Gerald Kimbrough (DIRECTOR) |
| Authorized Official Contact | 6623774685 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Medicine Residency Center 1665 S Green St Tupelo MS 38804-6556 Ph: (662) 377-2189 | Family Medicine Residency Center 1665 S Green St Tupelo MS 38804-6556 Ph: (662) 377-2189 |
| NPI Number | 1255692356 |
|---|---|
| Provider Enumeration Date | 06/05/2012 |
| Last Update Date | 05/06/2019 |
| Medicare PECOS PAC ID | 2961658950 |
|---|---|
| Medicare Enrollment ID | O20120807000540 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255692356 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | David J Brooks |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962440214 PECOS PAC ID: 7719953074 Enrollment ID: I20040908000608 |
| Provider Name | Dennis E Smith |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245279918 PECOS PAC ID: 6406854959 Enrollment ID: I20061117000315 |
| Provider Name | Karen A Hughes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780622035 PECOS PAC ID: 9032249206 Enrollment ID: I20100615000199 |
| Provider Name | Terry R Perrine |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033157391 PECOS PAC ID: 9234269424 Enrollment ID: I20100615000408 |
| Provider Name | Gina Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629580642 PECOS PAC ID: 8022374768 Enrollment ID: I20171113001536 |
| Provider Name | William P Davis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407237365 PECOS PAC ID: 8224325592 Enrollment ID: I20180626002065 |
| Provider Name | Terri Jo Teague |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255719415 PECOS PAC ID: 5294168019 Enrollment ID: I20191210001359 |
| Provider Name | Ethan Tillotson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194175273 PECOS PAC ID: 8224323183 Enrollment ID: I20200526003086 |
| Provider Name | Leslie Smothers |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851706477 PECOS PAC ID: 6103113162 Enrollment ID: I20200805003109 |
| Provider Name | Augusto Soltero |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346407814 PECOS PAC ID: 4688702665 Enrollment ID: I20200903001808 |
| Provider Name | Denaya Conley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952808958 PECOS PAC ID: 4082015995 Enrollment ID: I20221004000504 |
South Madison Medical Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1040a S. Madison St, Tupelo, MS 38801 Phone: 662-377-4685 Fax: 662-377-2755 | |
Nmmc Ekg Interpretations Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 830 S Gloster St, Tupelo, MS 38801 Phone: 662-377-4685 Fax: 662-377-2755 | |
North Mississippi Neurosurgical Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4381 S Eason Blvd, Suite 302, Tupelo, MS 38801 Phone: 662-377-5700 Fax: 662-377-5720 | |
Pontotoc Health Providers Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 450 E President Ave, Tupelo, MS 38801 Phone: 662-377-4685 Fax: 662-377-2057 | |
Grant Family Medical Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 805 Varsity Dr, Tupelo, MS 38801 Phone: 484-252-6707 | |
North Mississippi Medical Clinics Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 450 E President Ave, Tupelo, MS 38801 Phone: 662-377-4685 | |
Advanced Wound Center Professionals Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 830 S Gloster St, 1st Floor East Tower, Tupelo, MS 38801 Phone: 662-377-2395 Fax: 662-377-2397 |