Organization
SULLIVAN & SAMS MEDICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KERI TARANTINO (MANAGING AGENT)
(913) 526-5282
Entity
Organization
Contact information
Practice address
104 E ASHLAND AVE, MT ZION, IL 62549-1271
(217) 864-8364
Mailing address
104 E ASHLAND AVE, MT ZION, IL 62549-1271
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
01/29/2019
Last updated
07/13/2022
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