| Sullivan Medical Clinic | |
|
11325 W Expressway 83 Sullivan TX 78595 | |
| (956) 485-1401 | |
| (956) 485-0107 |
| Full Name | Sullivan Medical Clinic |
|---|---|
| Speciality | Family Medicine - Adolescent Medicine |
| Location | 11325 W Expressway 83, Sullivan, Texas |
| Authorized Official Name and Position | Louis Gesler Madhere (CEO) |
| Authorized Official Contact | 9564851401 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sullivan Medical Clinic Po Box 250 Sullivan City TX 78595-0250 Ph: (956) 485-1401 | Sullivan Medical Clinic 11325 W Expressway 83 Sullivan TX 78595 Ph: (956) 485-1401 |
| NPI Number | 1205919214 |
|---|---|
| Provider Enumeration Date | 10/23/2006 |
| Last Update Date | 09/25/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205919214 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | (Texas) | Secondary |
| 207QA0000X | Family Medicine - Adolescent Medicine | (Texas) | Primary |