=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104807262
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUN MEDICAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2005
-----------------------------------------------------
Last Update Date | 06/26/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1880 N 725 W
-----------------------------------------------------
City | BARGERSVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46106-9002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-422-8185
-----------------------------------------------------
Fax | 317-422-4722
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1880 N 725 W
-----------------------------------------------------
City | BARGERSVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46106-9002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-422-8185
-----------------------------------------------------
Fax | 317-422-4722
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. MICHAEL W POTTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 317-422-8185
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | N/A
-----------------------------------------------------
License Number State |
-----------------------------------------------------