Provider Demographics
NPI:1558369769
Name:SULLIVAN RESPIRATORY SERVICES, P.S.C.
Entity Type:Organization
Organization Name:SULLIVAN RESPIRATORY SERVICES, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:RCP
Authorized Official - Phone:502-349-0999
Mailing Address - Street 1:703 MCDOWELL BLVD
Mailing Address - Street 2:STE. 100A
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-2651
Mailing Address - Country:US
Mailing Address - Phone:502-349-0999
Mailing Address - Fax:502-635-5829
Practice Address - Street 1:703 MCDOWELL BLVD
Practice Address - Street 2:STE. 100A
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2651
Practice Address - Country:US
Practice Address - Phone:502-349-0999
Practice Address - Fax:502-635-5829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4275240001Medicare NSC