Healthcare Provider Details

I. General information

NPI: 1659541118
Provider Name (Legal Business Name): SUN HEALTH MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10515 W SANTA FE DR
SUN CITY AZ
85351-3020
US

IV. Provider business mailing address

PO BOX 1278 ATTN: MINDY OGDEN
SUN CITY AZ
85372-1278
US

V. Phone/Fax

Practice location:
  • Phone: 623-815-7661
  • Fax: 623-815-2981
Mailing address:
  • Phone: 623-544-5075
  • Fax: 623-544-5093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM T SELLNER
Title or Position: CFO
Credential:
Phone: 623-876-6616