Provider Demographics
NPI:1871058529
Name:SULLIVAN COUNTY INTERNAL MEDICINE LLC
Entity type:Organization
Organization Name:SULLIVAN COUNTY INTERNAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:DIVYESH
Authorized Official - Middle Name:
Authorized Official - Last Name:PUROHIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-249-9904
Mailing Address - Street 1:3991 GOLF BAG LN
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-8145
Mailing Address - Country:US
Mailing Address - Phone:812-249-9904
Mailing Address - Fax:812-316-5151
Practice Address - Street 1:557 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SHELBURN
Practice Address - State:IN
Practice Address - Zip Code:47879-1232
Practice Address - Country:US
Practice Address - Phone:812-397-2440
Practice Address - Fax:812-397-0164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-07
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty