=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407056708
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN THOMAS SULLIVAN PA-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2007
-----------------------------------------------------
Last Update Date | 10/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 522 W NEWTON ST STE 300
-----------------------------------------------------
City | GREENSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15601-2890
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-838-7500
-----------------------------------------------------
Fax | 724-837-6670
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4811 E GRANT RD STE 261
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85712-2776
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-618-1010
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 6307
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------