Healthcare Provider Details

I. General information

NPI: 1194831396
Provider Name (Legal Business Name): SULLIVAN EMS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 PLEASANT ST
SULLIVAN WI
53178-9764
US

IV. Provider business mailing address

PO BOX 72140
CEDARBURG WI
53012-7340
US

V. Phone/Fax

Practice location:
  • Phone: 262-593-2333
  • Fax:
Mailing address:
  • Phone: 262-375-9610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID SULIK
Title or Position: BILLING MANAGER
Credential:
Phone: 262-375-9610