Healthcare Provider Details

I. General information

NPI: 1336884725
Provider Name (Legal Business Name): S4 SPECIALTY CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2022
Last Update Date: 05/01/2022
Certification Date: 05/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N HIGH SCHOOL RD
INDIANAPOLIS IN
46214-3759
US

IV. Provider business mailing address

2063 FINCHLEY RD
CARMEL IN
46032-7337
US

V. Phone/Fax

Practice location:
  • Phone: 615-478-3720
  • Fax:
Mailing address:
  • Phone: 615-478-3720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JEREMY T SULLIVAN
Title or Position: OWNER
Credential: MD
Phone: 615-478-3720