Healthcare Provider Details

I. General information

NPI: 1497311062
Provider Name (Legal Business Name): STEVEN GLEN SULLIVAN CRT, RPSGT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2019
Last Update Date: 05/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 HOPE RD
BRANCHVILLE SC
29432
US

IV. Provider business mailing address

803 HOPE RD
BRANCHVILLE SC
29432
US

V. Phone/Fax

Practice location:
  • Phone: 803-331-5772
  • Fax:
Mailing address:
  • Phone: 803-331-5772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number3273
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: