Active NPI
David Sullivan
- Home Modifications Contractor
- Perry, FL
National Provider Identifier
1053733253
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Modifications Contractor
- License
- JB2110
- Practice address
- 2823 Glover Carlton Rd
Perry, FL 32348-7640 - Phone
- (850) 584-4775
- Fax
- (850) 584-4735
- NPI assigned
- Jan 8, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Modifications Contractor | 171WH0202X | JB2110 | FL | Primary |
Addresses
Primary practice location
2823 Glover Carlton Rd
Perry, FL 32348-7640
Mailing address
2823 Glover Carlton Rd
Perry, FL 32348-7640
Phone (850) 584-4775
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 690734200 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| JB2110 | FL | MD | Home Modifications Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1389139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389225600000",
"number": "1053733253",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2823 GLOVER CARLTON RD",
"city": "PERRY",
"state": "FL",
"postal_code": "323487640",
"telephone_number": "850-584-4775",
"fax_number": "850-584-4735"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2823 GLOVER CARLTON RD",
"city": "PERRY",
"state": "FL",
"postal_code": "323487640",
"telephone_number": "850-584-4775",
"fax_number": "850-584-4735"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "DAVID",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-01-08",
"last_updated": "2014-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "171WH0202X",
"taxonomy_group": "",
"desc": "Contractor, Home Modifications",
"state": "FL",
"license": "JB2110",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "690734200",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Perry, FL
- Latricia Slaughter
- Abdul Hamid Sofi, M.D.
- Emily Elizabeth Starks, PTA
- Connie Alford Steele, OTR
- Sarah Caitlyn Straka, APRN, FNP-C
- Tallahassee Memorial Healthcare Inc
- Tallahassee Orthopedic Clinic III PL
- Tallahassee Podiatry Associates PA
- Taylor County Recovery Center, Inc.
- Taylor County School District
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.