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General NPI Number Information
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NPI Number | 1629379078
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Entity Type | Organization
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Legal Business Name | BOLIVAR PHYSICIAN PRACTICES LLC
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Dates
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Enumeration Date | 11/16/2010
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Last Update Date | 11/23/2010
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Provider Practice Location Address
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Address Line | 903 EAST SUNFLOWER RD SUITE 400
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City | CLEVELAND
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State | MS
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Zip | 38732-2551
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Country | US
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Telephone | 662-846-5687
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Fax | 662-846-2891
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Provider Business Mailing Address
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Address Line | 903 EAST SUNFLOWER RD SUITE 400
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City | CLEVELAND
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State | MS
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Zip | 38732-2551
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Country | US
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Telephone | 662-846-5687
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Fax | 662-846-2891
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Authorized Official
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Title or Position | DIRECTOR/OFFICER
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Name | DAVID M DILL
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Credential |
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Telephone | 662-846-5687
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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