Healthcare Provider Details

I. General information

NPI: 1013128644
Provider Name (Legal Business Name): NORTH SUNFLOWER MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 06/08/2020
Certification Date: 06/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 N OAK AVE
RULEVILLE MS
38771-3227
US

IV. Provider business mailing address

PO BOX 369
RULEVILLE MS
38771-0369
US

V. Phone/Fax

Practice location:
  • Phone: 662-756-2711
  • Fax: 662-756-4114
Mailing address:
  • Phone: 662-756-2711
  • Fax: 662-756-4114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number11-168
License Number StateMS

VIII. Authorized Official

Name: MR. JOSE D CEJA
Title or Position: CEO
Credential:
Phone: 662-756-2711