Provider Demographics
NPI:1629379078
Name:BOLIVAR PHYSICIAN PRACTICES LLC
Entity Type:Organization
Organization Name:BOLIVAR PHYSICIAN PRACTICES LLC
Other - Org Name:DELTA NEUROLOGY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:DILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-846-5687
Mailing Address - Street 1:903 EAST SUNFLOWER RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-2551
Mailing Address - Country:US
Mailing Address - Phone:662-846-5687
Mailing Address - Fax:662-846-2891
Practice Address - Street 1:903 EAST SUNFLOWER RD
Practice Address - Street 2:SUITE 400
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2551
Practice Address - Country:US
Practice Address - Phone:662-846-5687
Practice Address - Fax:662-846-2891
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFEPOINT HOSPITALS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-16
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty