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General NPI Number Information
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NPI Number | 1457357543
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Entity Type | Organization
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Legal Business Name | BOLIVAR ENT, INC
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Dates
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Enumeration Date | 06/22/2005
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Last Update Date | 03/25/2008
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Provider Practice Location Address
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Address Line | 907 E SUNFLOWER RD SUITE 104
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City | CLEVELAND
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State | MS
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Zip | 38732-2830
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Country | US
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Telephone | 662-843-8801
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1389
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City | CLEVELAND
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State | MS
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Zip | 38732-1389
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Country | US
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Telephone | 662-843-8801
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PETER MCARTHUR
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Credential | M.D.
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Telephone | 662-843-8801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 17632
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License Number State | MS
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