C EUGENE SULLIVAN M.D. NPI 1649453903

NPI Information

NPI: 1649453903
Provider Name: C EUGENE SULLIVAN, M.D.
Classification: Specialist - 174400000X
Entity Type: Individual
Address:
210 W JEFFERSON ST
BOISE, ID
ZIP 83702
Phone: (208) 344-9424
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C Eugene Sullivan, M.D. is a specialist in Boise, ID. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. C Eugene Sullivan, M.D. NPI is 1649453903. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

210 W JEFFERSON ST
BOISE, ID
ZIP 83702-044
Phone: (208) 344-9424
Fax: (208) 343-3263

The enumeration date for this NPI number is 12/10/2007 and was last updated on 12/10/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	174400000X	Specialist		M3232	IDAHO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0024588	MEDICAID	IDAHO
2	E08600	MEDICARE UPIN	IDAHO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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