1487824330 NPI number — SUN HEALTH MEDICAL GROUP, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487824330 NPI number — SUN HEALTH MEDICAL GROUP, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUN HEALTH MEDICAL GROUP, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SUN HEALTH NEUROSURGICAL ASSOCIATES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487824330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1278
Provider Second Line Business Mailing Address:
ATTN: MINDY OGDEN
Provider Business Mailing Address City Name:
SUN CITY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85372-1278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-544-5075
Provider Business Mailing Address Fax Number:
623-544-5093

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13188 N 103RD DR
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
SUN CITY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85351-3064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-972-3001
Provider Business Practice Location Address Fax Number:
623-933-3045
Provider Enumeration Date:
03/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BROSOR
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
R
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
623-544-5079

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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