Basic Information
| Provider Information | |||||||||
| NPI: | 1235175803 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SULLIVAN URGENT AID CENTERS, LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 87844 | ||||||||
| Address2: | |||||||||
| City: | CAROL STREAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601887844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308751500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6701 159TH ST | ||||||||
| Address2: | |||||||||
| City: | TINLEY PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604771758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084293300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2006 | ||||||||
| LastUpdateDate: | 10/27/2010 | ||||||||
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| AuthorizedOfficialLastName: | SULLIVAN | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6307859100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.