Provider Demographics
NPI:1053519678
Name:SULLIVAN ASTHMA AND ALLERGY CARE PC
Entity type:Organization
Organization Name:SULLIVAN ASTHMA AND ALLERGY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-302-5020
Mailing Address - Street 1:3098 CAMPBELL STATION PKWY
Mailing Address - Street 2:SUITE A202
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174
Mailing Address - Country:US
Mailing Address - Phone:615-302-5020
Mailing Address - Fax:615-302-5025
Practice Address - Street 1:3098 CAMPBELL STATION PKWY
Practice Address - Street 2:SUITE A202
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174
Practice Address - Country:US
Practice Address - Phone:615-302-5020
Practice Address - Fax:615-302-5025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38819207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty