MEDICARE: SUNRISE DME, 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1336594571
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE DME, LLC

Provider Business Mailing Address
First Line	:	8101 N 10TH PL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-3707
Country	:	US
Telephone Number	:	602-686-8788
Fax Number	:

Provider Business Practice Location Address
First Line	:	8101 N 10TH PL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-3707
Country	:	US
Telephone Number	:	602-686-8788
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JODIE COLLEEN CRAWFORD
Credential	:
Telephone Number	:	602-686-8788

Provider Enumeration Date	:	04/25/2016
Last Update Date	:	04/25/2016

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