Healthcare Provider Details

I. General information

NPI: 1245283597
Provider Name (Legal Business Name): SUN HEALTH LAKES IMAGING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10474 W THUNDERBIRD BLVD SUITE 100
SUN CITY AZ
85351-3015
US

IV. Provider business mailing address

PO BOX 5430
SUN CITY WEST AZ
85376-5430
US

V. Phone/Fax

Practice location:
  • Phone: 623-876-5351
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberOTC-3641
License Number StateAZ

VIII. Authorized Official

Name: NANCY BURTON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 623-876-5356