Provider Demographics
NPI:1508047473
Name:CARSON DOUGLAS PAIN CARE, JAMES H. SULLIVAN, M.D., LTD.
Entity Type:Organization
Organization Name:CARSON DOUGLAS PAIN CARE, JAMES H. SULLIVAN, M.D., LTD.
Other - Org Name:CARSON DOUGLAS PAIN CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:775-267-9222
Mailing Address - Street 1:PO BOX 689
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89702-0689
Mailing Address - Country:US
Mailing Address - Phone:775-267-9222
Mailing Address - Fax:775-267-9225
Practice Address - Street 1:973 MICA DR
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89705-7170
Practice Address - Country:US
Practice Address - Phone:775-267-9222
Practice Address - Fax:775-267-9225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6200174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1538268529OtherNPI
1891804712OtherNPI
1164521142OtherNPI
1891804712OtherNPI
A50945Medicare UPIN