Provider Demographics
NPI:1336420587
Name:TYLER HOLMES WALK-IN CLINIC
Entity Type:Organization
Organization Name:TYLER HOLMES WALK-IN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:H
Authorized Official - Last Name:MCCRARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-283-6121
Mailing Address - Street 1:409 TYLER HOLMES DR
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MS
Mailing Address - Zip Code:38967-1521
Mailing Address - Country:US
Mailing Address - Phone:662-283-5295
Mailing Address - Fax:662-283-5296
Practice Address - Street 1:409 TYLER HOLMES DR
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MS
Practice Address - Zip Code:38967-1521
Practice Address - Country:US
Practice Address - Phone:662-283-5295
Practice Address - Fax:662-283-5296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR659983261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center