Healthcare Provider Details

I. General information

NPI: 1881001501
Provider Name (Legal Business Name): NORTH SUNFLOWER MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 N OAK AVE
RULEVILLE MS
38771
US

IV. Provider business mailing address

860 N OAK AVE
RULEVILLE MS
38771-3227
US

V. Phone/Fax

Practice location:
  • Phone: 662-756-2711
  • Fax: 662-756-1699
Mailing address:
  • Phone: 662-756-2711
  • Fax: 662-756-1699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BILLY MARLOW
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 662-756-1782