Healthcare Provider Details

I. General information

NPI: 1013574342
Provider Name (Legal Business Name): SUN COUNTRY MEDICAL EQUIPMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 S WALNUT ST STE B12
LAS CRUCES NM
88001-2616
US

IV. Provider business mailing address

151 S WALNUT ST STE B12
LAS CRUCES NM
88001-2616
US

V. Phone/Fax

Practice location:
  • Phone: 575-800-0890
  • Fax: 575-800-0895
Mailing address:
  • Phone: 575-800-0890
  • Fax: 575-800-0895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: HADYA HAYDAR
Title or Position: COO
Credential:
Phone: 915-592-4346