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General NPI Number Information
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NPI Number | 1821360298
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Entity Type | Organization
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Legal Business Name | MARY ANN CHAVEZ DO
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Dates
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Enumeration Date | 02/01/2012
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Last Update Date | 01/31/2013
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Provider Practice Location Address
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Address Line | 1120 N SECTION ST SULLIVAN MEDICAL CLINIC
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City | SULLIVAN
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State | IN
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Zip | 47882-9200
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Country | US
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Telephone | 812-268-3901
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Fax | 812-268-0674
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Provider Business Mailing Address
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Address Line | 1120 N SECTION ST
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City | SULLIVAN
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State | IN
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Zip | 47882-9200
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Country | US
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Telephone | 812-268-3901
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Fax | 812-268-0674
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Authorized Official
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Title or Position | OWNER/SOLE PROPRIETOR
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Name | MARY ANN CHAVEZ
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Credential | DO
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Telephone | 812-268-3901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 02002313A
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License Number State | IN
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