# CLEVELAND MEDICAL CLINIC PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134347958
- **Authorized official:** MRS. TOMMICILE DEAN ROGERS (ADMINISTRATOR)
- **Authorized official phone:** (662) 843-3606

## Contact information

- **Practice address:** 810 E SUNFLOWER RD, SUITE 100A, CLEVELAND, MS 38732-2800
- **Practice address phone:** (662) 843-3606
- **Practice address fax:** (662) 846-1194
- **Mailing address:** PO BOX 1629, CLEVELAND, MS 38732-1629
- **Mailing address phone:** (662) 843-3606
- **Mailing address fax:** (662) 846-1194

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |

## Other

- **Enumeration date:** 04/24/2007
- **Last updated:** 02/05/2008