Organization
PHC-CLEVELAND LLC
Active
Other names
Bolivar Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNETTA TRAYLOR PESC (DIRECTOR)
(502) 596-6063
Entity
Organization
Contact information
Practice address
901 E SUNFLOWER RD, CLEVELAND, MS 38732-2833
(662) 846-0061
(662) 846-2380
Mailing address
680 S 4TH ST, LOUISVILLE, KY 40202-2407
(502) 212-8481
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
16224
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0220606
—
MS
Enumeration date
01/25/2006
Last updated
06/10/2025
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