1578515110 NPI number — SUN HEALTH CORPORATION

Table of content: (NPI 1578515110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578515110 NPI number — SUN HEALTH CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUN HEALTH CORPORATION
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 DEL E. WEBB HOSPITAL
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:
1578515110
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 29892
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85038-9892
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-214-4004
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14502 W MEEKER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUN CITY WEST
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85375-5282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-214-4004
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ADKINS
Authorized Official First Name:
JO
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
623-214-4001

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  H0168 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 770000001000 . This is a "TMG" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0201090 . This is a "BCBSAZ" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: IZ0082 . This is a "HEALTH NET WEBB" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: F01388 . This is a "PHOENIX HEALTH PLAN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 025305 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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