BOLIVAR UROLOGY CLINIC, PA (NPI# 1588785794) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588785794 |
| Entity Type | Organization |
| Organization Name | BOLIVAR UROLOGY CLINIC, PA |
| Practice Address |
907 E Sunflower Rd Suite 103 Cleveland MS 38732-2830 |
| Practice Telephone | 6628469990 |
| Mailing Telephone | 6628469990 |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. DEREK MILES (PRESIDENT) |
| Authorized Official Telephone | 6628469990 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | 17441 | MS | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 09016081 | 05 | |
| MS | 00126078 | 05 | |
| MS | INDIVIDUAL PROVIDER NPI | 1407887391 | 01 |
| Street Address |
907 E SUNFLOWER RD SUITE 103 |
| City | CLEVELAND |
| State | MS |
| Zip Code | 38732-2830 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457357543 | Bolivar Ent, Inc | Otolaryngology | 907 E Sunflower Rd, Suite 104, Cleveland, MS 38732-2830 | 2005-06-22 |
| 1316388416 | Bolivar Physician Practices LLC | Urology | 907 E Sunflower Rd, Suite 103, Cleveland, MS 38732-2830 | 2013-07-17 |
| 1235404377 | Delta Wound Care Pllc | Preventive Medicine | 907 E Sunflower Rd, Suite 102, Cleveland, MS 38732-2830 | 2012-03-21 |
| 1063659530 | Bolivar Physician Practices LLC | Orthopaedic Surgery | 907 E Sunflower Rd, Suite 102, Cleveland, MS 38732-2830 | 2009-01-20 |
| 1518136613 | Michael D Braswell | Durable Medical Equipment & Medical Supplies | 907 E Sunflower Rd, Suite 102, Cleveland, MS 38732-2830 | 2008-02-22 |
| 1255475836 | Michael Braswell | Specialist | 907 E Sunflower Rd, Suite 102, Cleveland, MS 38732-2830 | 2007-02-16 |
| 1063596757 | Nelson Medical Consulting, Inc. | Family Medicine | 907 E Sunflower Rd, Ste 101, Cleveland, MS 38732-2830 | 2006-10-25 |
| 1336220276 | Scott Nelson | Family Medicine | 907 E Sunflower Rd, Ste 101, Cleveland, MS 38732-2830 | 2006-10-18 |
| 1407887391 | Derek Miles | Urology | 907 E Sunflower Rd, Suite 103, Cleveland, MS 38732-2830 | 2006-07-06 |
| 1023049335 | Roger Alan Blake | Specialist | 907 E Sunflower Rd, 101, Cleveland, MS 38732-2830 | 2006-07-05 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023629219 | Marilynn Pruitt | Technician | 108 Belvedere Court, Cleveland, MS 38732 | 2020-08-12 |
| 1417322587 | United Family Life Center | Clinic/Center | 1101 S Martin Luther King Drive, Cleveland, MS 38732 | 2015-12-01 |
| 1346661584 | Rebecca Winters | Speech-Language Pathologist | 4036 Hwy 8 East, Cleveland, MS 38732 | 2013-12-13 |
| 1982973186 | Delta Home Health Inc | Home Health | 300-b South Street, Cleveland, MS 38732 | 2011-12-19 |
| 1730467382 | Reid Farmer Davis Medico | Clinic/Center | 4080 Highway 8 West, Cleveland, MS 38732 | 2011-08-01 |
| 1700181427 | Sondra Speakes Huerta | Speech-Language Pathologist | 3939 Hwy 61 N. Suite 110, Cleveland, MS 38732 | 2011-01-12 |
| 1386956027 | Delta Soul Medical, LLC | Hospice Care, Community Based | 102 N. Pearman Ave., Ste. 1, Cleveland, MS 38732 | 2010-07-10 |
| 1700029675 | Jlrl, LLC | Dentist | 716 First Street, Cleveland, MS 38732 | 2009-04-08 |
| 1417194978 | Bolivar Emergency Group LLC | Physician Assistant | 901 Hwy 8 East Sunflower Rd, Cleveland, MS 38732 | 2009-01-20 |
| 1902055767 | Word of Deliverance Adult Day Care | Custodial Care Facility | 509 Davis Avenue, Cleveland, MS 38732 | 2008-09-16 |
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| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194232876 | Nathan Ying-ho Hoy | Urology | 9500 Euclid Ave, Q10, Cleveland, OH 44195 | 2018-01-04 |
| 1750808580 | Clyde Alexander Kyle | Urology | 448 Kyle Ln Nw, Cleveland, TN 37312-6435 | 2017-08-23 |
| 1144607508 | Johnathan Doolittle | Urology | 2050 E 96th St Q Building, Cleveland, OH 44195-3548 | 2015-05-05 |
| 1427374974 | Jessica Helen Hannick | Urology | 11100 Euclid Ave # Rbc2311, Cleveland, OH 44106 | 2010-04-08 |
| 1073836623 | Juan Antonio Jimenez | Urology | 18099 Lorain Ave Ste 141, Cleveland, OH 44111-5611 | 2010-03-10 |
| 1851550321 | Georges-pascal Haber | Urology | 9500 Euclid Ave /a100, Cleveland Clinic - Urology, Cleveland, OH 44195 | 2008-06-09 |
| 1699947333 | Anil Abraham Thomas | Urology | Glickman Urological Institute A100, Cleveland Clinic Foundation, Cleveland, OH 44195-0001 | 2008-04-01 |
| 1487826244 | Matthew Neil Simmons | Urology | Cleveland Clinic - Glickman Urological Institute, 9500 Euclid Ave A100, Cleveland, OH 44195-0001 | 2008-04-01 |
| 1588833305 | Hadley Merrideth Wood | Urology | Glickman Urological Institute/a100, 9500 Euclid Avenue, Cleveland, OH 44195-0001 | 2008-02-26 |
| 1982751921 | Grant Pegram Simmons | Urology | 400 Berywood Trl Nw Ste B, Cleveland, TN 37312-5288 | 2007-01-04 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.