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NPI Code Detail

MEDICARE: SUN LIFE FAMILY HEALTH CENTER, INC.

MEDICARE: SUN LIFE FAMILY HEALTH CENTER, INC.
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
1261QF0400XFederally Qualified Health Center (FQHC)258AZ

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2ZFQ31813OTHERMEDICARE PTAN

Other Identifiers

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

General Provider Information

NPI Number : 1588876429
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUN LIFE FAMILY HEALTH CENTER, INC.
Provider Business Mailing Address
First Line : PO BOX 10097
Second Line :
City : CASA GRANDE
State : AZ
Zip : 85130-0020
Country : US
Telephone Number : 520-836-3446
Fax Number : 520-836-8807
Provider Business Practice Location Address
First Line : 205 N STUART BLVD
Second Line :
City : ELOY
State : AZ
Zip : 85131-2507
Country : US
Telephone Number : 520-466-7883
Fax Number : 520-466-3946
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : TRAVIS ROBINETTE
Credential :
Telephone Number : 520-836-3446
Provider Enumeration Date : 05/04/2007
Last Update Date : 08/03/2017

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