MEDICARE: SUNSET MEDICAL CLINIC LLC

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	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093702367
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSET MEDICAL CLINIC LLC

Provider Business Mailing Address
First Line	:	990 NAPOLEON AVENUE
Second Line	:
City	:	SUNSET
State	:	LA
Zip	:	70584-6100
Country	:	US
Telephone Number	:	337-662-7290
Fax Number	:

Provider Business Practice Location Address
First Line	:	990 NAPOLEON AVENUE
Second Line	:
City	:	SUNSET
State	:	LA
Zip	:	70584-6100
Country	:	US
Telephone Number	:	337-662-7290
Fax Number	:

Authorized Official
Title or Position	:	PARTNER/MD
Name	:	RANDY JAMES DAIGLE
Credential	:	MD
Telephone Number	:	337-662-7290

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	11/23/2010

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