Organization
SULLIVAN FAMILY PRACTICE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSAN LYNN HELMAN (ADMINISTRATOR)
(812) 268-3318
Entity
Organization
Contact information
Practice address
2229 MARY SHERMAN DR, SULLIVAN, IN 47882-7633
(812) 268-3318
(812) 268-4017
Mailing address
2229 MARY SHERMAN DR, PO BOX 230, SULLIVAN, IN 47882-7633
(812) 268-3318
(812) 268-4017
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01036108
IN
261QR1300X
Rural Health Clinic/Center
01036108
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
153868
RURAL HEALTH CLINIC
IN
05
—
200015680A
—
IN
Enumeration date
07/19/2006
Last updated
10/26/2009
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