Spencer K Sullivan

MD | Pediatric Hematology-Oncology | Male

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Complete Profile:

Spencer K Sullivan basic information including his official name, gender, specialization, credentials etc. are as mentioned below.

Specialization :	Pediatrics Pediatric Hematology-Oncology
Provider Name :	Spencer K Sullivan
Credential :	MD
Gender :	Male

Business Address:

Spencer K Sullivan address, contact phone number and fax are as below. Patients can directly walkin to the clinic or can call on the below given phone number for appointment.

Primary Address :	7730 Old Canton Rd Bldg B Madison, MS, 39110 United States
Phone Number :	601-499-0935
Fax Number :	601-499-0936

Professional Identification Codes:

NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). NPI details are as mentioned below.

NPI Number :	1073735114
NPI Entity Type :	Individual
First Enrolment Date :	02 May, 2007
Last Updated On :	18 Jun, 2019

Medicare Participation:

Spencer K Sullivan participates in medicare and accepts medicare insurance either directly or through association with group practice or medical facility.

Medicare PECOS ID :	0749445195
Medicare Enrollment ID :	I20140804000267
Primary Specialty :	Hematology/oncology
Medical School :	University Of North Carolina At Chapel Hill School Of Medicine
Graduation Year :	2005
Accepts Medicare?	Yes. Spencer K Sullivan accepts medicare insurance.

Group Practice Association:

Spencer K Sullivan is associated with following Group Practice Organizations. Group practices are practice of medicine by a group of physicians who share their premises and other resources. Following list states all the group name with which Spencer K Sullivan is associated with along with the number of members in that group. He may also accept medicare indirectly via these group practices.

Organisation Name :	Group Practice ID	No. of Members	Practice Address	Group Accepts Medicare
Mississippi Center For Advanced Medicine, Pc	1951693282	8	840 N Oak Ave Ruleville, MS - 387713227 Ph: 6014990935	Yes
Mississippi Center For Advanced Medicine, Pc	1951693282	8	401 Baptist Dr Suite 301 Madison, MS - 391102012 Ph: 6014990935	Yes

Licenses and Specialities:

Physicians/Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Spencer K Sullivan are as mentioned. Primary taxonomy code for Spencer K Sullivan, MD is 2080P0207X (Pediatrics Pediatric Hematology-Oncology).

Taxonomy Code	Speciality	Primary	License No.	State
2080P0207X	Pediatrics Pediatric Hematology-Oncology	Yes	23304	MS

Legacy Identifiers:

Other legacy medical identifiers of Spencer K Sullivan such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned below.

Identifier	Identifier Type	State	Issuer
01212067	MEDICAID	MS

Other Practice Locations:

Practice Address	City, State	Phone Number
7731 OLD CANTON RD, STE B MADISON, MS, 39110-9233 United States	MADISON, MS	601-499-0935

Mailing Address:

Mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned business address only.

Mailing Address :	7731 Old Canton Rd Ste B Madison, MS, 39110-6115 United States
Phone Number :	601-499-0935
Fax Number :	601-499-0936

Business Location:

Patients can refer following map for directions to Spencer K Sullivan practice address. Don't forget to take prior appointment before visiting.
** Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 08 January, 2024.