=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346584836
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEBSTER HEALTH SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2012
-----------------------------------------------------
Last Update Date | 01/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15 MEDICAL PLZ
-----------------------------------------------------
City | EUPORA
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39744-4019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-258-4701
-----------------------------------------------------
Fax | 662-258-4215
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 808 VARSITY DR
-----------------------------------------------------
City | TUPELO
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38801-4613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-377-3204
-----------------------------------------------------
Fax | 662-377-2057
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CORPORATE SECRETARY
-----------------------------------------------------
Name | MR. BRUCE TOPPIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 662-377-4229
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number | 13-225
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------