Provider Demographics
NPI:1154488393
Name:NORTH SUNFLOWER MEDICAL CENTER
Entity Type:Organization
Organization Name:NORTH SUNFLOWER MEDICAL CENTER
Other - Org Name:SUNFLOWER RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:D
Authorized Official - Last Name:CEJA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:662-756-2711
Mailing Address - Street 1:840 N OAK AVE
Mailing Address - Street 2:
Mailing Address - City:RULEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38771-3227
Mailing Address - Country:US
Mailing Address - Phone:662-756-4024
Mailing Address - Fax:662-756-4023
Practice Address - Street 1:840 N OAK AVE
Practice Address - Street 2:
Practice Address - City:RULEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38771-3227
Practice Address - Country:US
Practice Address - Phone:662-756-4024
Practice Address - Fax:662-756-4023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11-168261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS9013863Medicaid
MS09013627Medicaid
MSC00159Medicare ID - Type UnspecifiedRADIOLOGY PRO FEES
MSC00727Medicare ID - Type UnspecifiedPRO FEES PART B
MS09013627Medicaid