Organization
SULLIVAN SURGICENTER,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CUSTODIO L LIM MD (CEO)
(812) 268-9000
Entity
Organization
Contact information
Practice address
320 N SECTION ST, SULLIVAN, IN 47882-1239
(812) 268-9000
(812) 268-8822
Mailing address
320 N SECTION ST, SULLIVAN, IN 47882-1239
(812) 268-9000
(812) 268-8822
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
05-003633-1
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200503030
—
IN
Enumeration date
03/10/2006
Last updated
12/06/2012
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