Provider Demographics
NPI:1053314559
Name:SULLIVAN PARAMEDICINE, INC
Entity Type:Organization
Organization Name:SULLIVAN PARAMEDICINE, INC
Other - Org Name:MOBILEMEDIC EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-436-9111
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:HURLEYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12747-0001
Mailing Address - Country:US
Mailing Address - Phone:845-436-9111
Mailing Address - Fax:845-436-8313
Practice Address - Street 1:266 MAIN ST
Practice Address - Street 2:
Practice Address - City:HURLEYVILLE
Practice Address - State:NY
Practice Address - Zip Code:12747-5431
Practice Address - Country:US
Practice Address - Phone:845-436-9111
Practice Address - Fax:845-436-8313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY09295146L00000X, 146M00000X, 146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Multi-Specialty
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, IntermediateGroup - Multi-Specialty
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02415772Medicaid
NY=========OtherTAX ID NUMBER