Provider Demographics
NPI:1588201495
Name:WEBB FAMILY MEDICAL CLINIC PLLC
Entity Type:Organization
Organization Name:WEBB FAMILY MEDICAL CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:NERREN
Authorized Official - Suffix:III
Authorized Official - Credentials:CPA
Authorized Official - Phone:662-714-4460
Mailing Address - Street 1:1200 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:WATER VALLEY
Mailing Address - State:MS
Mailing Address - Zip Code:38965-1904
Mailing Address - Country:US
Mailing Address - Phone:662-714-4460
Mailing Address - Fax:662-714-4480
Practice Address - Street 1:1200 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:WATER VALLEY
Practice Address - State:MS
Practice Address - Zip Code:38965-1904
Practice Address - Country:US
Practice Address - Phone:662-714-4460
Practice Address - Fax:662-714-4480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-10
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS17582OtherMISSISSIPPI STATE BOARD OF MEDICAL LICENSURE
1548357981OtherNPPES
MS17582OtherMISSISSIPPI STATE BOARD OF MEDICAL LICENSURE