1588611677 NPI number — SUNSET IMAGING, LLC

Table of content: (NPI 1588611677)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588611677 NPI number — SUNSET IMAGING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNSET IMAGING, 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:
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:
1588611677
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7717
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCEAN ISLE BEACH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28469-1717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-575-6552
Provider Business Mailing Address Fax Number:
910-575-6690

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
850 SUNSET BLVD N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUNSET BEACH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28468-4262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-575-6552
Provider Business Practice Location Address Fax Number:
910-575-6690
Provider Enumeration Date:
05/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BASTUG
Authorized Official First Name:
DEMIR
Authorized Official Middle Name:
EROL
Authorized Official Title or Position:
MEMBER/MANAGER
Authorized Official Telephone Number:
910-575-6552

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 017M3 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2881826A . This is a "MEDICARE SECOND SITE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5902630 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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