Healthcare Provider Details

I. General information

NPI: 1518648096
Provider Name (Legal Business Name): NORTH SUNFLOWER MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 10/31/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W PARK AVE
GREENWOOD MS
38930-3008
US

IV. Provider business mailing address

PO BOX 219
RULEVILLE MS
38771-0219
US

V. Phone/Fax

Practice location:
  • Phone: 662-219-2733
  • Fax: 662-219-2751
Mailing address:
  • Phone: 662-756-2711
  • Fax: 662-756-1810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL LEE MILLER
Title or Position: (COO) CHIEF OPERATING OFFICER
Credential: DNP, RN, CENP, NHA
Phone: 662-756-2711