MEDICARE: SUNSET MEDICAL GROUP

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	174400000X	Specialist

General Provider Information

NPI Number	:	1164665782
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSET MEDICAL GROUP

Provider Business Mailing Address
First Line	:	901 TOWN CENTRE BLVD
Second Line	:	SUITE 115
City	:	CLAYTON
State	:	NC
Zip	:	27520-2181
Country	:	US
Telephone Number	:	800-803-0717
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 TOWN CENTRE BLVD
Second Line	:	SUITE 115
City	:	CLAYTON
State	:	NC
Zip	:	27520-2181
Country	:	US
Telephone Number	:	800-803-0717
Fax Number	:

Authorized Official
Title or Position	:	OPERATING OFFICER
Name	:	CORY GELMON
Credential	:
Telephone Number	:	800-803-0717

Provider Enumeration Date	:	04/13/2009
Last Update Date	:	04/13/2009

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