Vincent E. Sullivan MD PC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

18213 Issued in IA

Legal business name

VINCENT E. SULLIVAN MD PC

Doing business as

Surgery Clinic

Practice address

19878 Saint Joseph Dr
Centerville, IA 52544-8850

Phone

(641) 437-1576

Fax

(641) 437-4205

NPI assigned

Nov 27, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Vincent Edward Sullivan, M.D.NPI 1750361036

Title

Owner

Phone

(641) 437-1576

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Surgery Clinic Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Vincent E. Sullivan, M.D.

  • Surgery Physician
  • Centerville, IA
  • NPI 1750361036
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196121600000",
    "number": "1174705628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19878 SAINT JOSEPH DR",
            "address_2": "P.O. BOX 160",
            "city": "CENTERVILLE",
            "state": "IA",
            "postal_code": "525448850",
            "telephone_number": "641-437-1576",
            "fax_number": "641-437-4205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19878 SAINT JOSEPH DR",
            "city": "CENTERVILLE",
            "state": "IA",
            "postal_code": "525448850",
            "telephone_number": "641-437-1576",
            "fax_number": "641-437-4205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VINCENT E. SULLIVAN MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-27",
        "last_updated": "2007-11-27",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "VINCENT",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "641-437-1576",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "IA",
            "license": "18213",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0186270",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Surgery Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Surgery Physician in Centerville, IA
• Providers in Centerville, IA by specialty
• Surgery Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.