SPENCER K SULLIVAN (NPI# 1073735114) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073735114 |
| Entity Type | Individual |
| Full Name | SPENCER K SULLIVAN |
| Credential | MD |
| Practice Address |
7730 Old Canton Rd Bldg B Madison MS 39110 |
| Mailing Address |
7731 Old Canton Rd Ste B Madison MS 39110-6115 |
| Practice Telephone | 6014990935 |
| Practice Fax Number | 6014990936 |
| Mailing Telephone | 6014990935 |
| Mailing Fax Number | 6014990936 |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2019-06-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0207X |
Pediatrics Specialization: Pediatric Hematology-Oncology |
23304 | MS | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 01212067 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 7731 Old Canton Rd, Ste B, Madison, MS 391109233 | 6014990935 | 6014990936 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144863085 | Spencer Annabelle Sullivan | Behavior Technician | 877 Ygnacio Valley Rd Ste 100, Walnut Creek, CA 94596-3897 | 2019-10-23 |
| Street Address |
7730 OLD CANTON RD BLDG B |
| City | MADISON |
| State | MS |
| Zip Code | 39110 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154324366 | Ray Jaime Rodriguez | Allergy & Immunology | 7730 Old Canton Rd Bldg B, Madison, MS 39110-9299 | 2005-05-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134784689 | Therapy South - Gluckstadt LLC | Physical Therapist | 1716 Us 51, Ste N, Madison, MS 39110 | 2019-05-09 |
| 1871054098 | Summit Medical Solutions | Durable Medical Equipment & Medical Supplies | 107 Azalea Street, Madison, MS 39110 | 2019-03-29 |
| 1912488198 | Madison Medical Compounding Pharmacy | Pharmacy | 111 Fountains Blvd. Building B Ste. A, Madison, MS 39110 | 2018-08-24 |
| 1679061469 | Nuvena Vein Clinic | Anesthesiology | 120 Fountains Blvd, Madison, MS 39110 | 2018-04-26 |
| 1467960484 | Brick City Drugs, LLC | Durable Medical Equipment & Medical Supplies | 159 Fountains Blvd, Madison, MS 39110 | 2018-01-11 |
| 1093227589 | Hannah Monk Hawthorne | Counselor | 930 Ebenezer Blvd., Suite D, Madisin, MS 39110 | 2017-10-25 |
| 1548786650 | Kimberly Allen | Pharmacist | 1100 Us- 51, Madison, MS 39110 | 2017-08-21 |
| 1891218186 | Delta Elizabeth Stark | Chiropractor | 1085 Gluckstadt Rd., Bld 300 Ste E, Madison, MS 39110 | 2017-07-19 |
| 1861914848 | Laura Hartlein | Dietitian, Registered | 200 Park Circle Dr. #2, Flowood, MS 39110 | 2017-07-12 |
| 1831620608 | Ona Irby | Occupational Therapist | 105 Munich Dr, Madison, MS 39110 | 2017-03-23 |
| Find all providers in zip 39110 | ||||
| Taxonomy Code | 2080P0207X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Hematology-Oncology |
| A pediatrician trained in the combination of pediatrics, hematology and oncology to recognize and manage pediatric blood disorders and cancerous diseases. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pediatrics. The Certification is no longer offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801015136 | Sharon Marie Pennington | Pediatrics | 7730 Old Canton Road, Building B, Madison, MS 39110 | 2007-04-25 |
| 1205951126 | Neha J Patel | Pediatrics | 321 Shiloh Dr, Madison, WI 53705-2462 | 2007-03-20 |
| 1942430715 | Cathy A Lee-miller | Pediatrics | 1675 Highland Ave, Madison, WI 53792-7710 | 2009-07-15 |
| 1568616787 | Chu Ri Shin | Pediatrics | 600 Highland Ave, Madison, WI 53792-0001 | 2008-11-14 |
| 1306064654 | Mario Otto | Pediatrics | 600 Highland Ave, Madison, WI 53792-0001 | 2007-04-23 |
| 1376697359 | Christian Matthew Capitini | Pediatrics | 1111 Highland Ave, Wimr 4137, Madison, WI 53705-2275 | 2007-01-23 |
| 1275591075 | Inga Hofmann Zhang | Pediatrics | 600 Highland Ave, Madison, WI 53792-0001 | 2006-05-02 |
| 1427027317 | Kenneth B Desantes | Pediatrics | 600 Highland Ave, Madison, WI 53792 | 2006-03-14 |
| 1205802360 | Paul M Sondel | Pediatrics | 600 Highland Ave, Madison, WI 53792 | 2006-02-27 |
| 1487620126 | Carol A Diamond | Pediatrics | 600 Highland Ave, Madison, WI 53792 | 2006-02-23 |
| Find all providers in MADISON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.