MEDICARE: MOUNTAIN SUN MEDICAL, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QC1500X	Community Health Clinic/Center

General Provider Information

NPI Number	:	1073493359
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN SUN MEDICAL, PLLC

Provider Business Mailing Address
First Line	:	1240B E STRINGHAM AVE STE 1034
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-2490
Country	:	US
Telephone Number	:	801-796-2641
Fax Number	:	205-891-1270

Provider Business Practice Location Address
First Line	:	1240 E STRINGHAM AVE STE 1034
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-2560
Country	:	US
Telephone Number	:	801-796-2641
Fax Number	:	205-891-1270

Authorized Official
Title or Position	:	TENURED PHYSICIAN
Name	:	DR. ADAM BINNEBOESE
Credential	:	MD
Telephone Number	:	801-796-2641

Provider Enumeration Date	:	09/05/2025
Last Update Date	:	09/05/2025

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