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NPI Code Detail

MEDICARE: PHC-CLEVELAND LLC

MEDICARE: PHC-CLEVELAND LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1282N00000XGeneral Acute Care Hospital16224MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457321036
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHC-CLEVELAND LLC
Provider Business Mailing Address
First Line : 680 S 4TH ST
Second Line :
City : LOUISVILLE
State : KY
Zip : 40202-2407
Country : US
Telephone Number :
Fax Number : 502-212-8481
Provider Business Practice Location Address
First Line : 901 E SUNFLOWER RD
Second Line :
City : CLEVELAND
State : MS
Zip : 38732-2833
Country : US
Telephone Number : 662-846-0061
Fax Number : 662-846-2380
Authorized Official
Title or Position : DIRECTOR
Name : JOHNETTA TRAYLOR
Credential : PESC
Telephone Number : 502-596-6063
Provider Enumeration Date : 01/25/2006
Last Update Date : 06/10/2025

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Directions to “PHC-CLEVELAND LLC ” Practice Location

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