Provider Demographics
NPI:1508913609
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:DANIEL
Authorized Official - Last Name:CEJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-756-2711
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:RULEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38771-0369
Mailing Address - Country:US
Mailing Address - Phone:662-756-2711
Mailing Address - Fax:662-756-4114
Practice Address - Street 1:840 N OAK AVE
Practice Address - Street 2:
Practice Address - City:RULEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38771-0369
Practice Address - Country:US
Practice Address - Phone:662-756-2711
Practice Address - Fax:662-756-4114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11-168282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09013431Medicaid
MS09013432Medicaid
MS09013627Medicaid
MS00020118Medicaid
MS251318Medicare Oscar/Certification
MS09013432Medicaid
MS00020118Medicaid