Healthcare Provider Details

I. General information

NPI: 1003494576
Provider Name (Legal Business Name): WEBSTER HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 TURNER ST
MABEN MS
39750-9157
US

IV. Provider business mailing address

830 S GLOSTER ST
TUPELO MS
38801-4934
US

V. Phone/Fax

Practice location:
  • Phone: 662-263-5900
  • Fax:
Mailing address:
  • Phone: 662-377-3611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEBBIE GALE HALLMARK
Title or Position: DIRECTOR OF REIMBURSEMENT
Credential:
Phone: 662-377-5186