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General NPI Number Information
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NPI Number | 1245283597
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Entity Type | Organization
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Legal Business Name | SUN HEALTH LAKES IMAGING CENTER
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10474 W THUNDERBIRD BLVD SUITE 100
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City | SUN CITY
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State | AZ
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Zip | 85351-3015
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Country | US
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Telephone | 623-876-5351
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5430
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City | SUN CITY WEST
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State | AZ
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Zip | 85376-5430
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | NANCY BURTON
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Credential |
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Telephone | 623-876-5356
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | OTC-3641
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License Number State | AZ
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