Sullivan Medical Corporation

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SULLIVAN MEDICAL CORPORATION

Practice address

1175 E Arrow Highway Suite B
Upland, CA 91786

Phone

(909) 985-1891

Fax

(909) 985-0121

NPI assigned

Sep 15, 2006

Organization subpart

No

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

Authorized official

Name

Mr. John W Sullivan, MD

Title

Vice-President

Phone

(909) 985-1891

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1790881092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1175 E ARROW HIGHWAY SUITE B",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "91786",
            "telephone_number": "909-985-1891",
            "fax_number": "909-985-0121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1175 E ARROW HIGHWAY SUITE B",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "91786",
            "telephone_number": "909-985-1891",
            "fax_number": "909-985-0121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SULLIVAN MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "VICE-PRESIDENT",
        "authorized_official_telephone_number": "909-985-1891",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A199910",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Upland, CA
• Providers in Upland, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.