1689843872 NPI number — SUN HEALTH MEDICAL GROUP LLC

Table of content: (NPI 1689843872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689843872 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 DEL E. WEBB HEALTH CENTER OF WICKENBURG
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:
1689843872
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2008
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:
1395 W WICKENBURG WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WICKENBURG
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85390-4231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-388-9957
Provider Business Practice Location Address Fax Number:
928-684-7457
Provider Enumeration Date:
02/21/2008

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, PHYSICIAN SERVICES
Authorized Official Telephone Number:
623-544-5079

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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