Healthcare Provider Details

I. General information

NPI: 1881926996
Provider Name (Legal Business Name): NORTH SUNFLOWER MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2010
Last Update Date: 02/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 S RUBY AVE
RULEVILLE MS
38771-3802
US

IV. Provider business mailing address

202 S RUBY AVE
RULEVILLE MS
38771-3802
US

V. Phone/Fax

Practice location:
  • Phone: 662-756-2711
  • Fax:
Mailing address:
  • Phone: 662-756-2711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: BILLY MARLOW
Title or Position: CEO
Credential:
Phone: 662-756-2711