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NPI Code Detail

MEDICARE: PATRICK SULLIVAN

MEDICARE: PATRICK SULLIVAN
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
1171M00000XCase Manager/Care Coordinator
2171M00000XCase Manager/Care CoordinatorLA

General Provider Information

NPI Number : 1710349303
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICK SULLIVAN
Provider Business Mailing Address
First Line : 4315 BLUEBONNET BLVD
Second Line :
City : BATON ROUGE
State : LA
Zip : 70809-9661
Country : US
Telephone Number : 225-223-6968
Fax Number :
Provider Business Practice Location Address
First Line : 4315 BLUEBONNET BLVD
Second Line :
City : BATON ROUGE
State : LA
Zip : 70809-9661
Country : US
Telephone Number : 225-223-6968
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2016
Last Update Date : 11/12/2019

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