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NPI Code Detail

MEDICARE: SUNRISE DIAGNOSTICS GROUP, LLC

MEDICARE: SUNRISE DIAGNOSTICS GROUP, 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
1291U00000XClinical Medical Laboratory

General Provider Information

NPI Number : 1952601411
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUNRISE DIAGNOSTICS GROUP, LLC
Provider Business Mailing Address
First Line : PO BOX 7240
Second Line :
City : JUPITER
State : FL
Zip : 33468-7240
Country : US
Telephone Number : 561-748-2889
Fax Number :
Provider Business Practice Location Address
First Line : 3185 BOUTWELL RD
Second Line :
City : LAKE WORTH
State : FL
Zip : 33461-2610
Country : US
Telephone Number : 561-748-2889
Fax Number :
Authorized Official
Title or Position : JUPITER PROFESSIONAL DEVELOPMENT
Name : KAREN BARLOW
Credential : PRESIDENT
Telephone Number : 561-748-2889
Provider Enumeration Date : 10/29/2010
Last Update Date : 06/07/2013

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