NPIMap

Organization Active NPI

North Sunflower Medical Center Dentists

  • Oral and Maxillofacial Surgery (Dentist)
  • Ruleville, MS
National Provider Identifier
1104037738
Registry record updated Jun 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
NORTH SUNFLOWER MEDICAL CENTER DENTISTS
Practice address
840 N Oak Ave
Ruleville, MS 38771-3227
Phone
(662) 756-2711
Fax
(662) 756-0306
NPI assigned
May 25, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Jose Daniel Ceja
Title
Ceo
Phone
(662) 756-2711

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X MS Primary

Addresses

Primary practice location

840 N Oak Ave
Ruleville, MS 38771-3227

Mailing address

PO Box 369
Ruleville, MS 38771-0369
Phone (662) 756-1601

Other identifiers 1

IdentifierTypeStateIssuer
09013627MedicaidMS

National Provider Directory

National Provider Directory
Tax ID family
Sunflower Greenwood Clinic19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591574400000",
    "number": "1104037738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 369",
            "city": "RULEVILLE",
            "state": "MS",
            "postal_code": "387710369",
            "telephone_number": "662-756-1601",
            "fax_number": "662-756-0306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 N OAK AVE",
            "city": "RULEVILLE",
            "state": "MS",
            "postal_code": "387713227",
            "telephone_number": "662-756-2711",
            "fax_number": "662-756-0306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SUNFLOWER MEDICAL CENTER DENTISTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-25",
        "last_updated": "2020-06-08",
        "certification_date": "2020-06-08",
        "status": "A",
        "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",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09013627",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ruleville, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.