Healthcare Provider Details

I. General information

NPI: 1902451552
Provider Name (Legal Business Name): SISU HEALTHCARE SOLUTIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2019
Last Update Date: 07/14/2021
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 S 52ND ST STE 110
TEMPE AZ
85281-9500
US

IV. Provider business mailing address

914 S 52ND ST STE 110
TEMPE AZ
85281-9500
US

V. Phone/Fax

Practice location:
  • Phone: 480-999-4488
  • Fax: 480-999-4488
Mailing address:
  • Phone: 480-999-4488
  • Fax: 480-999-4488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARCUS E ULM
Title or Position: PRESIDENT
Credential:
Phone: 702-577-1617