1689841850 NPI number — SUNRISE FAMILY MEDICAL CENTER

Table of content: (NPI 1689841850)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689841850 NPI number — SUNRISE FAMILY MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNRISE FAMILY MEDICAL CENTER
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:
Provider Other Organization Name Type Code:
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:
1689841850
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12359 SUNRISE VALLEY DR STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RESTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20191-3493
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-476-9300
Provider Business Mailing Address Fax Number:
703-476-9304

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12359 SUNRISE VALLEY DR STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RESTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20191-3493
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-476-9300
Provider Business Practice Location Address Fax Number:
703-476-9304
Provider Enumeration Date:
05/15/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BARAY
Authorized Official First Name:
AHMAD
Authorized Official Middle Name:
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
703-476-9300

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  BB7494901 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 106459 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 4127655 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: J738-0001 . This is a "CAREFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5763643 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1999094 . This is a "FIRST HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: G01498 . This is a "MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 010044481 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 297400 . This is a "AMERIGROUP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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