NPIMap

Organization Active NPI

Bolivar Physician Practices LLC

Doing business as Bolivar ENT

  • Otolaryngology Physician
  • Cleveland, MS
National Provider Identifier
1386076800
Registry record updated Jun 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
BOLIVAR PHYSICIAN PRACTICES LLC
Doing business as
Bolivar ENT
Practice address
903 E Sunflower Rd
Suite 400
Cleveland, MS 38732-2835
Phone
(662) 545-3205
Fax
(662) 545-3204
NPI assigned
Aug 7, 2013
Last updated
Jun 4, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2026

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

Authorized official

Name
Charlotte Lawrence
Title
Secretary
Phone
(615) 920-7000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X NU Primary

Addresses

Primary practice location

903 E Sunflower Rd
Suite 400
Cleveland, MS 38732-2835

Mailing address

903 E Sunflower Rd Ste 400
Cleveland, MS 38732-2836
Phone (662) 545-3205

Other names 1

  • Bolivar ENT Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Bolivar Physician Practices7 organizations share this tax ID, including this one
Part of
Bolivar Physician Practices

Other organizations with this tax ID 6

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

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1375833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780531200000",
    "number": "1386076800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "903 E SUNFLOWER RD STE 400",
            "city": "CLEVELAND",
            "state": "MS",
            "postal_code": "387322836",
            "telephone_number": "662-545-3205",
            "fax_number": "662-545-3204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 E SUNFLOWER RD",
            "address_2": "SUITE 400",
            "city": "CLEVELAND",
            "state": "MS",
            "postal_code": "387322835",
            "telephone_number": "662-545-3205",
            "fax_number": "662-545-3204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOLIVAR PHYSICIAN PRACTICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-07",
        "last_updated": "2026-06-04",
        "certification_date": "2026-06-04",
        "status": "A",
        "authorized_official_last_name": "LAWRENCE",
        "authorized_official_first_name": "CHARLOTTE",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "615-920-7000"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bolivar ENT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cleveland, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.