Provider Demographics
NPI:1831592088
Name:BUDE FAMILY MEDICAL
Entity type:Organization
Organization Name:BUDE FAMILY MEDICAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLEWARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-384-8126
Mailing Address - Street 1:136 MAIN ST N
Mailing Address - Street 2:
Mailing Address - City:BUDE
Mailing Address - State:MS
Mailing Address - Zip Code:39630-7117
Mailing Address - Country:US
Mailing Address - Phone:601-384-8100
Mailing Address - Fax:601-384-4100
Practice Address - Street 1:136 MAIN ST N
Practice Address - Street 2:
Practice Address - City:BUDE
Practice Address - State:MS
Practice Address - Zip Code:39630-7117
Practice Address - Country:US
Practice Address - Phone:601-384-8100
Practice Address - Fax:601-384-4100
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANKLIN COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health