Provider Demographics
NPI:1063659530
Name:BOLIVAR PHYSICIAN PRACTICES LLC
Entity Type:Organization
Organization Name:BOLIVAR PHYSICIAN PRACTICES LLC
Other - Org Name:BOLIVAR ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-843-8885
Mailing Address - Street 1:907 E SUNFLOWER RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-2830
Mailing Address - Country:US
Mailing Address - Phone:662-843-8885
Mailing Address - Fax:662-843-2280
Practice Address - Street 1:907 E SUNFLOWER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2830
Practice Address - Country:US
Practice Address - Phone:662-843-8885
Practice Address - Fax:662-843-2280
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFEPOINT HOSPITALS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-20
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty