# SULLIVAN MEDICAL CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205919214
- **Authorized official:** MR. LOUIS GESLER MADHERE PHYSICIAN ASSISTANT (CEO)
- **Authorized official phone:** (956) 485-1401

## Contact information

- **Practice address:** 11325 W EXPRESSWAY 83, SULLIVAN, TX 78595
- **Practice address phone:** (956) 485-1401
- **Practice address fax:** (956) 485-0107
- **Mailing address:** PO BOX 250, SULLIVAN CITY, TX 78595-0250
- **Mailing address phone:** (956) 485-1401
- **Mailing address fax:** (956) 485-1407

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0000X | Adolescent Medicine (Family Medicine) Physician | — | TX | Yes |
| 207QA0505X | Adult Medicine Physician | — | TX | — |

## Other

- **Enumeration date:** 10/23/2006
- **Last updated:** 09/25/2007