Provider Demographics
NPI:1376612895
Name:NORTH SUNFLOWER MEDICAL CENTER
Entity Type:Organization
Organization Name:NORTH SUNFLOWER MEDICAL CENTER
Other - Org Name:
Other - Org Type:
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:
Authorized Official - Credentials:
Authorized Official - Phone:662-756-2711
Mailing Address - Street 1:820 N OAK AVE
Mailing Address - Street 2:P O BOX 129
Mailing Address - City:RULEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38771-3215
Mailing Address - Country:US
Mailing Address - Phone:662-756-1660
Mailing Address - Fax:662-756-4030
Practice Address - Street 1:820 N OAK AVE
Practice Address - Street 2:
Practice Address - City:RULEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38771-3215
Practice Address - Country:US
Practice Address - Phone:662-756-1660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS06952/11.1332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06028568Medicaid
MS0941310002Medicare NSC