Bolivar Physician Practices LLC
Organization Active NPI Rural Health Clinic/Center · Rosedale, MS
NPI 1205489689 · NPPES record last updated Jun 4, 2026
Key facts
- NPI
- 1205489689
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- BOLIVAR PHYSICIAN PRACTICES LLC
- Practice address
- 512 Levee St
Rosedale, MS 38769-5507 - Phone
- (662) 759-6806
- Fax
- (662) 759-6771
- NPI assigned
- Jul 24, 2019
- Organization subpart
- No
Authorized official
- Name
- Charlotte Lawrence
- Title
- Secretary
- Phone
- (615) 920-7000
Other NPIs on the same Medicare enrollment 6
Corporate family (same tax ID) 6
Practitioners 41
-
Maghan Ashmore, FNP-BC
-
Jackie Barnes, NP
-
Chastity A Barnette, CFNP
-
Matthew Bear, DO
-
Kelli Bearden, NP-C
-
Charles E Brock Jr., M.D.
-
John A Carr, MD
-
Roger C Clapp Jr., M.D.
-
Steven Glenn Clark, M.D
-
Allison Hailman Doyle, D.O.
-
Natalie Roberts Dozier, FNP-C
-
Bethany Lee Greco, CFNP
-
Degail Jamar Hadley, D.O.
-
Beverly Burns Livingston, FNP-C
-
Keila Mayfield, FNP
-
Clare Adams Moore, FNP
-
Angela D Parish, CFNP
-
Brooke Scallion, FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090512000274 | MS | Part B Supplier - Clinic/Group Practice | 6305995895 |
Receives reassigned benefits from 42 practitioners 6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Cleveland, MS; Rosedale, MS |
National Provider Directory
- Tax ID family
- Bolivar Physician Practices LLC
Locations
907 E Sunflower Rd
Ste 400
Cleveland, MS 38732
Phone (662) 545-3205
905 E Sunflower Rd
Cleveland, MS 38732
Phone (662) 843-5371
903 E Sunflower Rd
Ste 100
Cleveland, MS 38732
Phone (662) 545-3205
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
512 Levee St
Rosedale, MS 38769-5507
Mailing address
330 Seven Springs Way
Brentwood, TN 37027-5098
Phone (615) 920-7000
Other names
- Rosedale Family Medical
Other providers in Rosedale, MS
- Angel of Mercy Hospice
- Valerie Orcutt Antici
- Delta Health Center, Inc
- Essential School Based Health Clinic
- Joel D Gibson
- Joy'S Loving Care Adult Daycare Center
- John William Lewis Jr.
All providers in Rosedale, MS · Rural Health Clinic/Center in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 4, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.