=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942901970
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNSHINE CARE PARTNERS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2023
-----------------------------------------------------
Last Update Date | 03/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 771 CARPENTERS WAY
-----------------------------------------------------
City | LAKELAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33809-3922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-491-6972
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12162 S WACO
-----------------------------------------------------
City | GLENPOOL
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-304-8119
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | RUSTY W MCMURRAY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 918-304-8119
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------