Basic Information
Provider Information | |||||||||
NPI: | 1144623315 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MCMULLEN | ||||||||
FirstName: | SARAH | ||||||||
MiddleName: | A | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | CLIFTON | ||||||||
OtherFirstName: | SARAH | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 236 | ||||||||
Address2: |   | ||||||||
City: | BATESVILLE | ||||||||
State: | IN | ||||||||
PostalCode: | 470060236 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8129323371 | ||||||||
FaxNumber: | 8129323506 | ||||||||
Practice Location | |||||||||
Address1: | 188 STATE ROAD 129 S | ||||||||
Address2: |   | ||||||||
City: | BATESVILLE | ||||||||
State: | IN | ||||||||
PostalCode: | 470067628 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8129346400 | ||||||||
FaxNumber: | 8129346330 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/02/2014 | ||||||||
LastUpdateDate: | 03/29/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/29/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 01078813A | IN | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
No ID Information.