SULLIVAN SURGICENTERLLC NPI 1700854072

NPI Information

NPI: 1700854072
Provider Name: SULLIVAN SURGICENTER,LLC
Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

CLIA Number: 15D1030552

Address:
320 N SECTION ST
SULLIVAN, IN
ZIP 47882
Phone: (812) 268-9000
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SULLIVAN SURGICENTER,LLC is an ambulatory surgical clinic center in Sullivan, IN. SULLIVAN SURGICENTER,LLC NPI is 1700854072. The provider is registered as an organization entity type.

The provider's business location address is:

320 N SECTION ST
SULLIVAN, IN
ZIP 47882-239
Phone: (812) 268-9000
Fax: (812) 268-8822

The provider's authorized official is Custodio L Lim .
The authorized official title is Ceo and has the following contact phone number (812) 268-9000.

The CLIA number assigned to this NPI record is 15D1030552 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/10/2006 and was last updated on 12/6/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QA1903X	Clinic/Center	Ambulatory Surgical	05-003633-1	INDIANA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	ZR5090	MEDICARE ID-TYPE UNSPECIFIED	INDIANA
2	200503030	MEDICAID	INDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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