Provider Demographics
NPI:1972885945
Name:ARTHRITIS CARE OF THE EASTERN SHORE, LLC
Entity Type:Organization
Organization Name:ARTHRITIS CARE OF THE EASTERN SHORE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-928-8804
Mailing Address - Street 1:3 MEDICAL PARK
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-1804
Mailing Address - Country:US
Mailing Address - Phone:251-928-8804
Mailing Address - Fax:251-929-3067
Practice Address - Street 1:3 MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-1804
Practice Address - Country:US
Practice Address - Phone:251-928-8804
Practice Address - Fax:251-929-3067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK12259207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000023997Medicaid
AL000023997Medicaid
AL000023997Medicare PIN