Provider Demographics
NPI:1891705133
Name:NORTH SUNFLOWER MEDICAL CENTER
Entity Type:Organization
Organization Name:NORTH SUNFLOWER MEDICAL CENTER
Other - Org Name:CLEVELAND MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOMMICILE
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-843-3606
Mailing Address - Street 1:810 E SUNFLOWER RD
Mailing Address - Street 2:SUITE 100-A
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-2800
Mailing Address - Country:US
Mailing Address - Phone:662-843-3606
Mailing Address - Fax:662-846-1194
Practice Address - Street 1:810 E SUNFLOWER RD
Practice Address - Street 2:SUITE 100-A
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2800
Practice Address - Country:US
Practice Address - Phone:662-843-3606
Practice Address - Fax:662-846-1194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty