MEDICARE: SULLIVAN COUNTY AUDITOR

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	3416L0300X	Land Ambulance	0001	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000186301	OTHER	IN	ANTHEM

General Provider Information

NPI Number	:	1558370189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SULLIVAN COUNTY AUDITOR

Provider Business Mailing Address
First Line	:	PO BOX 547
Second Line	:
City	:	WHEELING
State	:	IL
Zip	:	60090-0547
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1816 N SECTION ST
Second Line	:
City	:	SULLIVAN
State	:	IN
Zip	:	47882-7502
Country	:	US
Telephone Number	:	270-744-9600
Fax Number	:	270-744-0834

Authorized Official
Title or Position	:	COMMISSIONER
Name	:	ROBERT A DAVIS
Credential	:
Telephone Number	:	812-564-2342

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	03/13/2026

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Directions to “SULLIVAN COUNTY AUDITOR ” Practice Location

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