Bolivar Physician Practices LLC

NPI #1386076800 in Cleveland, Mississippi

Provider Information

NPI Number: 1386076800
Entity Type: Organization
Organization Name: Bolivar Physician Practices LLC
Subpart: Yes (part of a larger organization)
Parent Organization: BOLIVAR PHYSICIAN PRACTICES LLC
Primary Specialty: Otolaryngology
Enumeration Date: Aug 7, 2013
Last Updated: Sep 12, 2013

Practice Location

Address: 903 E SUNFLOWER RD
Address 2: SUITE 400
City: Cleveland
State: Mississippi
ZIP Code: 38732-2835
Phone: (662) 545-3205

Authorized Official

Name: JESS N JUDY
Title: PRESIDENT
Phone: (615) 372-8500

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Otolaryngology	207Y00000X	Primary

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Organizations

Provider Name	Specialty	City
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