| Sullivan County Internal Medicine Llc | |
|
557 W Broadway St Shelburn IN 47879-1232 | |
| (812) 397-2440 | |
| (812) 397-0164 |
| Full Name | Sullivan County Internal Medicine Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 557 W Broadway St, Shelburn, Indiana |
| Authorized Official Name and Position | Divyesh Purohit (M.D.) |
| Authorized Official Contact | 8122499904 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sullivan County Internal Medicine Llc 3991 Golf Bag Ln Terre Haute IN 47802-8145 Ph: (812) 249-9904 | Sullivan County Internal Medicine Llc 557 W Broadway St Shelburn IN 47879-1232 Ph: (812) 397-2440 |
| NPI Number | 1871058529 |
|---|---|
| Provider Enumeration Date | 02/07/2019 |
| Last Update Date | 09/14/2023 |
| Medicare PECOS PAC ID | 6305185398 |
|---|---|
| Medicare Enrollment ID | O20190311000196 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871058529 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Divyesh Purohit |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1326028309 PECOS PAC ID: 2668367137 Enrollment ID: I20040216000600 |
Shelburn Medical Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 557 W Broadway St, Shelburn, IN 47879 Phone: 812-397-2440 Fax: 812-397-0164 |