Organization
CHAD E SULLIVAN
Active
Other names
C & S Medical Supply
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHAD SULLIVAN (OWNER)
(281) 991-8354
Entity
Organization
Contact information
Practice address
4104 YELLOWSTONE DR, PASADENA, TX 77504-3427
(281) 991-8354
(281) 991-8352
Mailing address
4104 YELLOWSTONE DR, PASADENA, TX 77504-3427
(281) 991-8354
(281) 991-8352
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
0059509
TX
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0059509
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
148594801
—
TX
01
—
530853
BLUE CROSS BLUE SHIELD #
TX
Enumeration date
01/13/2007
Last updated
06/23/2008
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