Sullivan Medical Clinic | |
11325 W Expressway 83 Sullivan TX 78595 | |
(956) 485-1401 | |
(956) 485-0107 |
Full Name | Sullivan Medical Clinic |
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Speciality | Family Medicine - Adolescent Medicine |
Location | 11325 W Expressway 83, Sullivan, Texas |
Authorized Official Name and Position | Louis Gesler Madhere (CEO) |
Authorized Official Contact | 9564851401 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Sullivan Medical Clinic Po Box 250 Sullivan City TX 78595-0250 Ph: (956) 485-1401 | Sullivan Medical Clinic 11325 W Expressway 83 Sullivan TX 78595 Ph: (956) 485-1401 |
NPI Number | 1205919214 |
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Provider Enumeration Date | 10/23/2006 |
Last Update Date | 09/25/2007 |
Identifier | Type | State | Issuer |
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1205919214 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207QA0000X | Family Medicine - Adolescent Medicine | (Texas) | Primary |
207QA0505X | Family Medicine - Adult Medicine | (Texas) | Secondary |