1508926221 NPI number — NORTH SUNFLOWER MEDICAL CENTER HHA

Table of content: WYNN E. KANTEN P.T. (NPI 1053543041)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508926221 NPI number — NORTH SUNFLOWER MEDICAL CENTER HHA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH SUNFLOWER MEDICAL CENTER HHA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508926221
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 369
Provider Second Line Business Mailing Address:
840 NORTH OAK
Provider Business Mailing Address City Name:
RULEVILLE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38771-0369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-756-4676
Provider Business Mailing Address Fax Number:
662-756-2009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
840 N OAK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RULEVILLE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38771-3227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-756-4676
Provider Business Practice Location Address Fax Number:
662-756-2009
Provider Enumeration Date:
12/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CEJA
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
DANIEL
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
662-756-2711

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  8581 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00070518 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000070109 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com