| Organization Name: | SULLIVAN MEDICAL CLINIC |
| NPI Number: | 1205919214 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LOUIS GESLER MADHERE (CEO) |
| Mailing Address: | 11325 W Expressway 83 Sullivan |
| State: | TX US |
| Postal Code: | 78595 |
| Phone Number: | 9564851401 |
| Fax Number: | 9564850107 |
| NPI Enumeration Date: | 10/23/2006 |
| NPI Last Update Date: | 09/25/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207QA0505X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Family Medicine |
| Taxonomy Specialization: | Adult Medicine |
| Taxonomy Definition: | |