| Sullivan Md Pllc | |
|
5100 E Hwy 90 Suite B Sierra Vista AZ 85635-2443 | |
| (520) 417-9727 | |
| (520) 417-9733 |
| Full Name | Sullivan Md Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 5100 E Hwy 90, Sierra Vista, Arizona |
| Authorized Official Name and Position | William Robert Sullivan (PRESIDENT) |
| Authorized Official Contact | 5204179729 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sullivan Md Pllc 5100 E. Hwy. 90 Suite B Sierra Vista AZ 85635 Ph: (520) 417-9727 | Sullivan Md Pllc 5100 E Hwy 90 Suite B Sierra Vista AZ 85635-2443 Ph: (520) 417-9727 |
| NPI Number | 1851531933 |
|---|---|
| Provider Enumeration Date | 03/02/2009 |
| Last Update Date | 03/25/2009 |
| Medicare PECOS PAC ID | 0042377269 |
|---|---|
| Medicare Enrollment ID | O20090316000131 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851531933 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 22176 (Arizona) | Primary |
| Provider Name | William R Sullivan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1154483477 PECOS PAC ID: 4183605884 Enrollment ID: I20040527001276 |
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