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General NPI Number Information
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NPI Number | 1902005382
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Entity Type | Organization
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Legal Business Name | SUNRISE COMMUNITY HEALTH
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Dates
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Enumeration Date | 07/16/2007
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Last Update Date | 05/29/2023
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Provider Practice Location Address
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Address Line | 302 3RD ST SE STE 150
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City | LOVELAND
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State | CO
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Zip | 80537-6419
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Country | US
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Telephone | 970-669-4855
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Fax | 970-669-7389
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Provider Business Mailing Address
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Address Line | 2930 11TH AVE
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City | EVANS
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State | CO
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Zip | 80620
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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 | CFO
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Name | CATHY WOLFF
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Credential |
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Telephone | 970-346-2546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State | CO
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