MEDICARE: SUNSHINE COMMUNITY 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
1	261QF0400X	Federally Qualified Health Center (FQHC)	77895	AK

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	:	1699892307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSHINE COMMUNITY HEALTH CENTER INC

Provider Business Mailing Address
First Line	:	HC 89 BOX 8190
Second Line	:
City	:	TALKEETNA
State	:	AK
Zip	:	99676-9701
Country	:	US
Telephone Number	:	907-733-2273
Fax Number	:	907-733-1735

Provider Business Practice Location Address
First Line	:	24091 W LONG LAKE RD
Second Line	:
City	:	WILLOW
State	:	AK
Zip	:	99688-9999
Country	:	US
Telephone Number	:	907-495-4100
Fax Number	:	907-733-1735

Authorized Official
Title or Position	:	CEO
Name	:	MELODY PALERMO
Credential	:
Telephone Number	:	907-733-2273

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/25/2014

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