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NPI Code Detail

MEDICARE: CARSON DOUGLAS PAIN CARE, JAMES H. SULLIVAN, M.D., LTD.

MEDICARE: CARSON DOUGLAS PAIN CARE, JAMES H. SULLIVAN, M.D., LTD.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist6200NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11538268529OTHERNPI
21891804712OTHERNPI
31164521142OTHERNPI

General Provider Information

NPI Number : 1508047473
Entity Type Code : Organization
Provider Name (Legal Business Name) : CARSON DOUGLAS PAIN CARE, JAMES H. SULLIVAN, M.D., LTD.
Provider Business Mailing Address
First Line : PO BOX 689
Second Line :
City : CARSON CITY
State : NV
Zip : 89702-0689
Country : US
Telephone Number : 775-267-9222
Fax Number : 775-267-9225
Provider Business Practice Location Address
First Line : 973 MICA DR
Second Line :
City : CARSON CITY
State : NV
Zip : 89705-7170
Country : US
Telephone Number : 775-267-9222
Fax Number : 775-267-9225
Authorized Official
Title or Position : OWNER
Name : DR. CHRIS J GARRETT
Credential : M. D.
Telephone Number : 775-267-9222
Provider Enumeration Date : 11/20/2007
Last Update Date : 03/06/2008

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1538268529 — DR. CHRISTOPHER JOSEPH GARRETT M.D.
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