Clyde Sullivan (NPI# 1295939262, PAC ID# 5193876464) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is INTERNAL MEDICINE.
| Nation Provider ID (NPI) | 1295939262 |
| PAC ID by PECOS | 5193876464 |
| Professional Enrollment ID | I20170110000275 |
| Full Name | Clyde Sullivan |
| Organization Legal Name | EVANSTON CLINIC CORP |
| Address |
190 Arrowhead Dr Evanston WY 82930-9266 |
| Phone Number | 3077893636 |
| Gender | M |
| Medical School | UNIVERSITY OF TENNESSEE COLLEGE OF MEDICINE |
| Graduation Year | 2004 |
| Primary Specialty | INTERNAL MEDICINE |
| Group Practice PAC ID | 8325038094 |
| Number of Group Practice Members | 14 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 280065 | GREAT PLAINS HEALTH |
| 530032 | EVANSTON REGIONAL HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 190 Arrowhead Dr, Evanston, WY 82930-9266 | 3077893636 | EVANSTON CLINIC CORP |
| 601 W Leota St, Great Plains Health, North Platte, NE 69101-6598 | 3085688000 | NORTH PLATTE NEBRASKA HOSPITAL CORPORATION |
| 611 W Francis St, North Platte, NE 69101-0614 | NORTH PLATTE NEBRASKA HOSPITAL CORPORATION |
| Organization Legal Name | EVANSTON CLINIC CORP |
| Physicians | 17 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Corbin N Rasmussen | Physician Assistant | Evanston Clinic Corp | 196 Arrowhead Dr, Evanston, WY 82930-8752 |
| Steven W Babcock | Family Practice | Evanston Clinic Corp | 531 Pkwy Dr, Mountain View, WY 82939 |
| Eric C Hansen | Obstetrics/gynecology | Evanston Clinic Corp | 150 Arrowhead Dr, Suite 2, Evanston, WY 82930-9353 |
| Cal L Morrow | Family Medicine | Evanston Clinic Corp | 196 Arrowhead Dr, Suite 1, Evanston, WY 82930-8752 |
| Karrie L Knopf | Physician Assistant | Evanston Clinic Corp | 196 Arrowhead Dr, Evanston, WY 82930-8752 |
| Richard L England | Family Medicine | Evanston Clinic Corp | 196 Arrowhead Dr, Suite 1, Evanston, WY 82930-8752 |
| Carol C Kavanaugh | Internal Medicine | Evanston Clinic Corp | 196 Arrowhead Dr, Suite 2, Evanston, WY 82930-8752 |
| Micah D Pullins | Orthopedic Surgery | Evanston Clinic Corp | 196 Arrowhead Dr, Suite 7, Evanston, WY 82930-8752 |
| Gregory M Yasuda | General Surgery | Evanston Clinic Corp | 196 Arrowhead Dr, Suite 6, Evanston, WY 82930-8752 |
| Ian Kendrick | Family Medicine | Evanston Clinic Corp | 196 Arrowhead Dr, Evanston, WY 82930-8752 |
| Street Address |
190 ARROWHEAD DR |
| City | EVANSTON |
| State | WY |
| Zip | 82930-9266 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Nicole L Dyer | Internal Medicine | Evanston Hospital Corporation | 190 Arrowhead Dr, Evanston, WY 82930-9266 |
| Thomas C Laucomer | Emergency Medicine | Evanston Regional Physicians LLC | 190 Arrowhead Dr, Evanston, WY 82930-9266 |
| Bruce C Meyer | Internal Medicine | Evanston Regional Physicians LLC | 190 Arrowhead Dr, Evanston, WY 82930-9266 |
| Melissa Foster | Nurse Practitioner | Emergency Physicians Integrated Care LLC | 190 Arrowhead Dr, Evanston, WY 82930-9266 |
| James F Arango | Emergency Medicine | Evanston Regional Physicians LLC | 190 Arrowhead Dr, Evanston, WY 82930-9266 |
| David V Shewell | Emergency Medicine | Emergency Physicians Integrated Care LLC | 190 Arrowhead Dr, Evanston, WY 82930-9266 |
| Jason W Curtis | Diagnostic Radiology | Utah Valley Radiology Associates Inc | 190 Arrowhead Dr, Evanston, WY 82930-9266 |
| Eric N. Swensen | Family Medicine | Evanston Regional Physicians LLC | 190 Arrowhead Dr, Evanston, WY 82930-9266 |
| Marion C Bishop | Emergency Medicine | Emergency Physicians Integrated Care LLC | 190 Arrowhead Dr, Evanston, WY 82930-9266 |
| Daryl Mclaren | Emergency Medicine | Evanston Regional Physicians LLC | 190 Arrowhead Dr, Evanston, WY 82930-9266 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Carol D Davis | Occupational Therapy | 612 County Club Dr, Ot Services, Evanston, WY 82930 | |
| Vickie L Wood | Clinical Social Worker | Pioneer Counseling Services | 949 Ctr St, Evanston, WY 82930-3430 |
| William Bruce Bourland | Optometry | 701 Front St, Evanston, WY 82930-3522 | |
| Pamela R Fuller | Psychologist, Clinical | Frontier Psychological Associates | 724 Front St, Suite 230, Evanston, WY 82930-3568 |
| Juliet L Jett | Psychologist, Clinical | Frontier Psychological Associates | 724 Front St, Suite 230, Evanston, WY 82930-3568 |
| Cora J Klotzbach | Psychologist, Clinical | Frontier Psychological Associates | 724 Front St, Suite 230, Evanston, WY 82930-3568 |
| Denise M Debarre | Clinical Psychologist | Frontier Psychological Associates | 724 Front St, Suite 230, Evanston, WY 82930-3568 |
| David R Russell | Optometry | 720 6th St, Evanston, WY 82930-3702 | |
| Suzanne Petren | Clinical Psychologist | Mountain Regional Services, Inc | 50 Allegiance Cir, Evanston, WY 82930-3804 |
| Sheri L Montgomery | Occupational Therapy | 152 Fox Point Loop Rd, Evanston, WY 82930-4784 | |
| Find all physicians in zip 82930 | |||
| City | EVANSTON |
| Zip Code | 82930 |
| Specialty | INTERNAL MEDICINE |
| City + Specialty | EVANSTON + INTERNAL MEDICINE |
Please comment or provide details below to improve the information on Clyde Sullivan.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.