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General NPI Number Information
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NPI Number | 1528158532
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Entity Type | Organization
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Legal Business Name | PHC-CLEVELAND LLC
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 901 E SUNFLOWER RD
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City | CLEVELAND
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State | MS
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Zip | 38732-2833
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Country | US
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Telephone | 662-846-0061
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Fax | 662-846-5680
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Provider Business Mailing Address
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Address Line | 901 E SUNFLOWER RD
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City | CLEVELAND
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State | MS
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Zip | 38732-2833
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Country | US
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Telephone | 662-846-0061
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Fax | 662-846-2277
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JOHNETTA TRAYLOR
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Credential |
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Telephone | 502-596-6063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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