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
1	261QD0000X	Dental Clinic/Center	BL-16-58324	AZ

General Provider Information

NPI Number	:	1992166359
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	:	1864 E FLORENCE BLVD
Second Line	:	SUITE1
City	:	CASA GRANDE
State	:	AZ
Zip	:	85122-5457
Country	:	US
Telephone Number	:	520-836-3446
Fax Number	:	520-836-8807

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	TRAVIS J ROBINETTE
Credential	:
Telephone Number	:	520-836-3446

Provider Enumeration Date	:	03/14/2016
Last Update Date	:	08/03/2017

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