SULLIVAN MEDICAL CLINIC (NPI# 1205919214) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205919214 |
| Entity Type | Organization |
| Organization Name | SULLIVAN MEDICAL CLINIC |
| Practice Address |
11325 W Expressway 83 Sullivan TX 78595 |
| Mailing Address |
Po Box 250 Sullivan City TX 78595-0250 |
| Practice Telephone | 9564851401 |
| Practice Fax Number | 9564850107 |
| Mailing Telephone | 9564851401 |
| Mailing Fax Number | 9564851407 |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2007-09-25 |
| Authorized Official Name | MR. LOUIS GESLER MADHERE (CEO) |
| Authorized Official Telephone | 9564851401 |
| Authorized Official Credential | PHYSICIAN ASSIST |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207QA0505X |
Family Medicine Specialization: Adult Medicine |
TX | Allopathic & Osteopathic Physicians | |
| Y | 207QA0000X |
Family Medicine Specialization: Adolescent Medicine |
TX | Allopathic & Osteopathic Physicians |
| Street Address |
11325 W EXPRESSWAY 83 |
| City | SULLIVAN |
| State | TX |
| Zip Code | 78595 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760014096 | Judy G Tanguma | Technician | 517 Robin St, Sullivan City, TX 78595 | 2020-02-05 |
| 1710270533 | J&b Dme LLC | Durable Medical Equipment & Medical Supplies | 100 Flores St, Unit 2, Sullivan City, TX 78595 | 2011-05-26 |
| 1902083918 | Border Line D.m.e. | Durable Medical Equipment & Medical Supplies | 2800 W. Expressway 83, Sullivan, TX 78595 | 2008-01-22 |
| 1063601011 | La Fuente, Inc. | Clinic/Center | 1801 W. Hwy 83, Sullivan City, TX 78595 | 2007-10-16 |
| 1679761985 | Mi Generacion Adult Day Care Inc. | Day Training, Developmentally Disabled Services | 1603 W. Expressway 83 / Guadalupe Flores Road., Sullivan City, TX 78595 | 2007-10-11 |
| 1871704718 | La Fuente, Inc | Home Health | 801 W Highway 83, Sullivan City, TX 78595 | 2007-05-24 |
| 1295946127 | La Fuente Inc. | Clinic/Center | 1285 E Expressway 83, Sullivan City, TX 78595 | 2007-05-24 |
| 1376624882 | A & L Health Services Inc | Home Health | 1604 W Expressway 83, Ste C, Sullivan City, TX 78595 | 2006-10-18 |
| 1699744201 | Vela & Solis Inc | Contractor | 211 East Expressway 83, Suite D, Sullivan City, TX 78595 | 2006-03-16 |
| 1346242849 | La Fuente Dme, Inc. | Durable Medical Equipment & Medical Supplies | 307 E Expressway 83, Sullivan City, TX 78595 | 2005-08-15 |
| Find all providers in zip 78595 | ||||
| Taxonomy Code | 207QA0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Adolescent Medicine |
| A family medicine physician with multidisciplinary training in the unique physical, psychological and social characteristics of adolescents and their health care problems and needs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Family Medicine, 2007. http://www.theabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023676970 | Oscar Samuel Claros | Family Medicine | 11807 South Fwy Ste 360, Burleson, TX 76028-7045 | 2019-06-04 |
| 1548554355 | Chau Nguyen Md, Pa | Family Medicine | 7111 Harwin, Ste. #201, Houston, TX 77036-2131 | 2011-06-09 |
| 1659558195 | Connie Pham, M.d.,p.a. | Family Medicine | 2118 Scenic Dr, Georgetown, TX 78626-7728 | 2008-01-28 |
| 1144426198 | Muhammad M Uddin | Family Medicine | 4351 Dfw Tpke, Ste 150, Dallas, TX 75211-1501 | 2007-06-26 |
| 1760685804 | Janna Wilder | Family Medicine | 1 Trinity Pl # 80, San Antonio, TX 78212-4674 | 2007-06-07 |
| 1487737219 | Oscar Olfindo Enriquez | Family Medicine | 2801 Macarthur Dr Ste E, West Orange, TX 77630-4791 | 2006-10-23 |
| 1326155219 | Angela Yvette Mosley-nunnery | Family Medicine | 22710 Professional Dr., Ste#202, Kingwood, TX 77339 | 2006-08-24 |
| 1770520066 | Neil Stanton Levy | Family Medicine | 12531 Renoir Ln, Dallas, TX 75230-1749 | 2006-06-02 |
| 1003808379 | Everett L Warthan | Family Medicine | 3500 S Ih 35, Belton, TX 76513-9426 | 2005-08-22 |
| 1982606489 | Sarah B Carter | Family Medicine | 7771 E Highway 153, Winters, TX 79567 | 2005-08-15 |
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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.