=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235932989
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNRISE CLINICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2025
-----------------------------------------------------
Last Update Date | 03/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 220 S 3RD ST
-----------------------------------------------------
City | TUCUMCARI
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88401-2802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-461-8631
-----------------------------------------------------
Fax | 888-708-0683
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 117 CAMINO DE VIDA STE 300
-----------------------------------------------------
City | SANTA ROSA
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88435-2267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-472-4311
-----------------------------------------------------
Fax | 877-651-0289
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HUMAN RESOURCES
-----------------------------------------------------
Name | JESSICA SANCHEZ
-----------------------------------------------------
Credential | CREDENTIALING
-----------------------------------------------------
Telephone | 575-472-4311
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QF0400X
-----------------------------------------------------
Taxonomy Name | Federally Qualified Health Center (FQHC)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------