Healthcare Provider Details

I. General information

NPI: 1376612895
Provider Name (Legal Business Name): NORTH SUNFLOWER MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W FLOYCE ST
RULEVILLE MS
38771-3408
US

IV. Provider business mailing address

PO BOX 129
RULEVILLE MS
38771-0129
US

V. Phone/Fax

Practice location:
  • Phone: 662-756-1660
  • Fax: 662-756-4030
Mailing address:
  • Phone: 662-756-1660
  • Fax: 662-756-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number06952/11.1
License Number StateMS

VIII. Authorized Official

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