# PHC-CLEVELAND LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Bolivar Medical Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528158532
- **Authorized official:** JOHNETTA TRAYLOR (ADMINISTRATOR)
- **Authorized official phone:** (502) 596-6063

## Contact information

- **Practice address:** 901 E SUNFLOWER RD, CLEVELAND, MS 38732-2833
- **Practice address phone:** (662) 846-0061
- **Practice address fax:** (662) 846-5680
- **Mailing address:** 901 E SUNFLOWER RD, CLEVELAND, MS 38732-2833
- **Mailing address phone:** (662) 846-0061
- **Mailing address fax:** (662) 846-2277

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | Yes |
| 207L00000X | Anesthesiology Physician | — | — | Yes |
| 2085B0100X | Body Imaging Physician | — | NULL | — |
| 2085B0100X | Body Imaging Physician | — | — | — |
| 2085R0202X | Diagnostic Radiology Physician | — | NULL | — |
| 2085R0202X | Diagnostic Radiology Physician | — | — | — |
| 367500000X | Certified Registered Nurse Anesthetist | — | NULL | — |
| 367500000X | Certified Registered Nurse Anesthetist | — | — | — |

## Other

- **Enumeration date:** 10/13/2006
- **Last updated:** 09/22/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 9015261 | — | MS |