Healthcare Provider Details

I. General information

NPI: 1689807646
Provider Name (Legal Business Name): SUNRISE MEDICAL SUPPLYAGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2009
Last Update Date: 08/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 DARTMOUTH AVE
SPRING HILL FL
34606-5438
US

IV. Provider business mailing address

319 DARTMOUTH AVE
SPRING HILL FL
34606-5438
US

V. Phone/Fax

Practice location:
  • Phone: 352-686-6483
  • Fax: 727-489-6884
Mailing address:
  • Phone: 352-686-6483
  • Fax: 727-489-6884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: KEVIN M SULLIVAN
Title or Position: OWNER
Credential:
Phone: 386-561-0077