Provider Demographics
NPI:1447805965
Name:SULLIVAN COUNTY COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:SULLIVAN COUNTY COMMUNITY HOSPITAL
Other - Org Name:FAMILY PRACTICE ASSOCIATES OF SULLIVAN COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:D
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-268-4311
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:IN
Mailing Address - Zip Code:47882-0010
Mailing Address - Country:US
Mailing Address - Phone:812-268-4311
Mailing Address - Fax:
Practice Address - Street 1:2229 MARY SHERMAN DR
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:IN
Practice Address - Zip Code:47882-7633
Practice Address - Country:US
Practice Address - Phone:812-268-3318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty