Healthcare Provider Details

I. General information

NPI: 1164598421
Provider Name (Legal Business Name): SUNBURY CLINIC COMPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 ARCH ST
SUNBURY PA
17801-2212
US

IV. Provider business mailing address

330 FRANKLIN RD #135A-333
BRENTWOOD TN
37027-3280
US

V. Phone/Fax

Practice location:
  • Phone: 570-286-0303
  • Fax:
Mailing address:
  • Phone: 615-465-3152
  • Fax: 615-465-3017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: GARY NEWSOME
Title or Position: PRESIDENT
Credential:
Phone: 615-465-3152