Sullivan Surgicenter,LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

05-003633-1 Issued in IN

Legal business name

SULLIVAN SURGICENTER,LLC

Practice address

320 N Section St
Sullivan, IN 47882-1239

Phone

(812) 268-9000

Fax

(812) 268-8822

NPI assigned

Mar 10, 2006

Last updated

Dec 6, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Custodio L Lim, MDNPI 1063404259

Title

Ceo

Phone

(812) 268-9000

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Listed as

Sullivan Surgicenter LLCCCN 15C0001133

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Custodio L. Lim, MD

  • Surgery Physician
  • Terre Haute, IN
  • NPI 1063404259
  NPD (past) Authorized official

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

{
    "created_epoch": "1141948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354752000000",
    "number": "1700854072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 N SECTION ST",
            "city": "SULLIVAN",
            "state": "IN",
            "postal_code": "478821239",
            "telephone_number": "812-268-9000",
            "fax_number": "812-268-8822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 N SECTION ST",
            "city": "SULLIVAN",
            "state": "IN",
            "postal_code": "478821239",
            "telephone_number": "812-268-9000",
            "fax_number": "812-268-8822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SULLIVAN SURGICENTER,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-10",
        "last_updated": "2012-12-06",
        "status": "A",
        "authorized_official_last_name": "LIM",
        "authorized_official_first_name": "CUSTODIO",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "812-268-9000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "IN",
            "license": "05-003633-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200503030",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sullivan Family Dentistry, LLC
• Sullivan Family Eye Care P C
• Sullivan Family Practice, LLC
• Sullivan Health & Living Center, Inc.
• Sullivan Rehabilitation & Sports Physical Therapy, Inc.
• Alfred R Talens, MD
• Namrata Telugu
• Terre Haute Pulmonary & Pediatric Clinic, LLC (Sullivan Clinic 2 Dr Deshpande)
• The Waters of Sullivan Skilled Nursing Facility LLC
• Billie J Thurman, N.P.

• Ambulatory Surgical Clinic/Center in Sullivan, IN
• Providers in Sullivan, IN by specialty
• Ambulatory Surgical Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.