Organization
MARY ANN CHAVEZ DO
Active
Other names
Sullivan Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MARY ANN CHAVEZ DO (OWNER/SOLE PROPRIETOR)
(812) 268-3901
Entity
Organization
Contact information
Practice address
1120 N SECTION ST, SULLIVAN MEDICAL CLINIC, SULLIVAN, IN 47882-9200
(812) 268-3901
(812) 268-0674
Mailing address
1120 N SECTION ST, SULLIVAN, IN 47882-9200
(812) 268-3901
(812) 268-0674
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
02002313A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200343440
—
IN
Enumeration date
02/01/2012
Last updated
01/31/2013
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