Provider Demographics
NPI:1609927185
Name:CHAD E SULLIVAN
Entity Type:Organization
Organization Name:CHAD E SULLIVAN
Other - Org Name:C & S MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-991-8354
Mailing Address - Street 1:4104 YELLOWSTONE DR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-3427
Mailing Address - Country:US
Mailing Address - Phone:281-991-8354
Mailing Address - Fax:281-991-8352
Practice Address - Street 1:4104 YELLOWSTONE DR
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-3427
Practice Address - Country:US
Practice Address - Phone:281-991-8354
Practice Address - Fax:281-991-8352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-13
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0059509332900000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148594801Medicaid
TX530853OtherBLUE CROSS BLUE SHIELD #