Organization
PHC-CLEVELAND LLC
Active
Other names
Bolivar Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNETTA TRAYLOR (ADMINISTRATOR)
(502) 596-6063
Entity
Organization
Contact information
Practice address
901 E SUNFLOWER RD, CLEVELAND, MS 38732-2833
(662) 846-0061
(662) 846-5680
Mailing address
901 E SUNFLOWER RD, CLEVELAND, MS 38732-2833
(662) 846-0061
(662) 846-2277
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
2085B0100X
Body Imaging Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9015261
—
MS
Enumeration date
10/13/2006
Last updated
09/22/2025
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