MEDICARE: SUN RIVER HEALTH 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)	5901200R	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	W38731	OTHER	NY	GROUP MEDICARE

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	:	1881177533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUN RIVER HEALTH INC

Provider Business Mailing Address
First Line	:	PO BOX 5036
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10602-5036
Country	:	US
Telephone Number	:	914-734-8800
Fax Number	:	914-734-8786

Provider Business Practice Location Address
First Line	:	459 EAST 149TH STREET
Second Line	:	THE HUB HEALTH CENTER
City	:	BRONX
State	:	NY
Zip	:	10455-1314
Country	:	US
Telephone Number	:	855-681-8700
Fax Number	:	718-299-1420

Authorized Official
Title or Position	:	VP INFO/PRACTICE MGMT SYSTEMS
Name	:	ADAM K. LIPTON
Credential	:
Telephone Number	:	914-384-2375

Provider Enumeration Date	:	09/10/2018
Last Update Date	:	03/14/2022

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Directions to “SUN RIVER HEALTH INC ” Practice Location

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