MEDICARE: SULLIVANT MEDIX LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1174480230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SULLIVANT MEDIX LLC

Provider Business Mailing Address
First Line	:	6372 MARINELLI DR S
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43228-2320
Country	:	US
Telephone Number	:	614-218-4720
Fax Number	:

Provider Business Practice Location Address
First Line	:	6372 MARINELLI DR S
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43228-2320
Country	:	US
Telephone Number	:	614-218-4720
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. DAWOOD BASHARAT
Credential	:
Telephone Number	:	614-218-4720

Provider Enumeration Date	:	01/08/2026
Last Update Date	:	01/08/2026

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