Sullivan Medical Clinic

Primary specialty

Adolescent Medicine (Family Medicine) PhysicianTaxonomy code 207QA0000X

Legal business name

SULLIVAN MEDICAL CLINIC

Practice address

11325 W Expressway 83
Sullivan, TX 78595

Phone

(956) 485-1401

Fax

(956) 485-0107

NPI assigned

Oct 23, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Louis Gesler Madhere, PHYSICIAN ASSISTANT

Title

Ceo

Phone

(956) 485-1401

Specialties & licenses 2

Addresses

Practitioners 2

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

• Gesler Louis Madhere, PHYSICIAN ASSISTANT

  • Physician Assistant
  • Sullivan City, TX
  • NPI 1619904661
  NPD (past)
• Michael Max Pierre-Louis, M.D.

  • Family Medicine Physician
  • Mission, TX
  • NPI 1639159205
  NPD (past)

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190678400000",
    "number": "1205919214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 250",
            "city": "SULLIVAN CITY",
            "state": "TX",
            "postal_code": "785950250",
            "telephone_number": "956-485-1401",
            "fax_number": "956-485-1407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11325 W EXPRESSWAY 83",
            "city": "SULLIVAN",
            "state": "TX",
            "postal_code": "78595",
            "telephone_number": "956-485-1401",
            "fax_number": "956-485-0107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SULLIVAN MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2007-09-25",
        "status": "A",
        "authorized_official_last_name": "MADHERE",
        "authorized_official_first_name": "LOUIS",
        "authorized_official_middle_name": "GESLER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "956-485-1401",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHYSICIAN ASSISTANT"
    },
    "taxonomies": [
        {
            "code": "207QA0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adolescent Medicine",
            "state": "TX",
            "license": null,
            "primary": true
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": "TX",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Border Line D.M.E.
• Melissa Pena

• Adolescent Medicine (Family Medicine) Physician in Sullivan, TX
• Providers in Sullivan, TX by specialty
• Adolescent Medicine (Family Medicine) Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 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.