Healthcare Provider Details

I. General information

NPI: 1184903320
Provider Name (Legal Business Name): SUNRISE MEDICAL GROUP IV LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2011
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7369 SHERIDAN STREET SUITE 302B
HOLLYWOOD FL
33024
US

IV. Provider business mailing address

1445 ROSS AVENUE SUITE 1400
DALLAS TX
75202
US

V. Phone/Fax

Practice location:
  • Phone: 954-981-3700
  • Fax:
Mailing address:
  • Phone: 954-509-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFF KOURY
Title or Position: SVP REGIONAL OPERATIONS, TENET
Credential:
Phone: 714-428-6842