Provider Demographics
NPI:1851565170
Name:PHC-CLEVELAND INC
Entity Type:Organization
Organization Name:PHC-CLEVELAND INC
Other - Org Name:MAGNOLIA MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, CORPORATE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:TEAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-253-5121
Mailing Address - Street 1:1 HOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-2425
Mailing Address - Country:US
Mailing Address - Phone:662-721-1208
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2425
Practice Address - Country:US
Practice Address - Phone:662-721-1208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty