Sullivan Pediatrics, LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

2009003022 Issued in MO

Legal business name

SULLIVAN PEDIATRICS, LLC

Practice address

2614 Forum Blvd
Columbia, MO 65203-5431

Phone

(573) 999-1657

Fax

(650) 560-1839

NPI assigned

Dec 14, 2010

Last updated

Dec 14, 2010By 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. Janet Sullivan, M.D.

Title

Medical Director

Phone

(573) 999-1657

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1292284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292284800000",
    "number": "1780987750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2614 FORUM BLVD",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652035431",
            "telephone_number": "573-999-1657",
            "fax_number": "650-560-1839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2614 FORUM BLVD",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652035431",
            "telephone_number": "573-999-1657",
            "fax_number": "650-560-1839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SULLIVAN PEDIATRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-14",
        "last_updated": "2010-12-14",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "JANET",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "573-999-1657",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2009003022",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sudhir Batchu MD LLC (Columbia Center For Neurology and MS)
• Dennis Suich
• Ketevan Sulakvelidze
• Ayman O Suleiman, MD
• Nahid A Suleman, MD
• Janet Sullivan, MD
• Luanne S Sullivan, MSW, LCSW
• Renee Marie Sullivan, MD
• Sherri Dawn Sullivan, R.PH.
• Summer R Sullivan, LCSW

• Pediatrics Physician in Columbia, MO
• Providers in Columbia, MO by specialty
• Pediatrics Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2010; 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.