Provider Demographics
NPI:1376787556
Name:BOLIVAR PHYSICIAN PRACTICES LLC
Entity Type:Organization
Organization Name:BOLIVAR PHYSICIAN PRACTICES LLC
Other - Org Name:UNIVERSAL HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:N
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-843-8885
Mailing Address - Street 1:218 N PEARMAN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-2634
Mailing Address - Country:US
Mailing Address - Phone:662-298-1730
Mailing Address - Fax:
Practice Address - Street 1:218 N PEARMAN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2634
Practice Address - Country:US
Practice Address - Phone:662-298-1730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFEPOINT HOSPITALS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty