Provider Demographics
NPI:1760908495
Name:JW SULLIVAN CONSULTANTS PLLC.
Entity Type:Organization
Organization Name:JW SULLIVAN CONSULTANTS PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTH OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIRAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:682-582-7001
Mailing Address - Street 1:PO BOX 41
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47308-0041
Mailing Address - Country:US
Mailing Address - Phone:765-284-0493
Mailing Address - Fax:765-284-2434
Practice Address - Street 1:1800 PARK PLACE AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-1302
Practice Address - Country:US
Practice Address - Phone:682-703-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-15
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty