Provider Demographics
NPI:1992598338
Name:TUCKER MEDICAL MANAGEMENT SERVICES, LLC
Entity type:Organization
Organization Name:TUCKER MEDICAL MANAGEMENT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-415-7020
Mailing Address - Street 1:602 THRASHER PT
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5970
Mailing Address - Country:US
Mailing Address - Phone:423-603-3700
Mailing Address - Fax:
Practice Address - Street 1:2704 W OXFORD LOOP STE 117
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5728
Practice Address - Country:US
Practice Address - Phone:423-603-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty