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NPI Code Detail

MEDICARE: SUNSHINE OUTPATIENT CLINIC LLC

MEDICARE: SUNSHINE OUTPATIENT CLINIC LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261Q00000XClinic/Center

General Provider Information

NPI Number : 1174282065
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUNSHINE OUTPATIENT CLINIC LLC
Provider Business Mailing Address
First Line : 1701 ROBERT C BYRD DR
Second Line :
City : BECKLEY
State : WV
Zip : 25801
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1769 ROBERT C BYRD DR
Second Line :
City : BECKLEY
State : WV
Zip : 25801-8707
Country : US
Telephone Number : 304-222-2329
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DONNA JEAN EVANS
Credential : OTR/L
Telephone Number : 304-222-2329
Provider Enumeration Date : 12/08/2021
Last Update Date : 01/24/2023

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Directions to “SUNSHINE OUTPATIENT CLINIC LLC ” Practice Location

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