# SULLIVAN SURGICENTER,LLC

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

## Provider details

- **NPI number:** 1700854072
- **Authorized official:** DR. CUSTODIO L LIM MD (CEO)
- **Authorized official phone:** (812) 268-9000

## Contact information

- **Practice address:** 320 N SECTION ST, SULLIVAN, IN 47882-1239
- **Practice address phone:** (812) 268-9000
- **Practice address fax:** (812) 268-8822
- **Mailing address:** 320 N SECTION ST, SULLIVAN, IN 47882-1239
- **Mailing address phone:** (812) 268-9000
- **Mailing address fax:** (812) 268-8822

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 05-003633-1 | IN | Yes |

## Other

- **Enumeration date:** 03/10/2006
- **Last updated:** 12/06/2012