Healthcare Provider Details

I. General information

NPI: 1104354752
Provider Name (Legal Business Name): SUNBELT MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2017
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3988 E FORT LOWELL RD
TUCSON AZ
85712-1010
US

IV. Provider business mailing address

2850 NORTH COUNTRY CLUB ROAD
TUCSON AZ
85716-1910
US

V. Phone/Fax

Practice location:
  • Phone: 520-488-5291
  • Fax:
Mailing address:
  • Phone: 520-322-6274
  • Fax: 520-609-4496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EDWARD J HUDSON
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 520-322-6274