Organization
MARY ANN CHAVEZ DO
Active
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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