Provider Demographics
NPI:1053684498
Name:SUNNY VIEW MEDICAL CENTER, PLLC
Entity Type:Organization
Organization Name:SUNNY VIEW MEDICAL CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:TERRY
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-956-9595
Mailing Address - Street 1:4400 N 32ND ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3953
Mailing Address - Country:US
Mailing Address - Phone:602-956-9595
Mailing Address - Fax:602-956-3232
Practice Address - Street 1:4400 N 32ND ST
Practice Address - Street 2:SUITE 110
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3953
Practice Address - Country:US
Practice Address - Phone:602-956-9595
Practice Address - Fax:602-956-3232
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNNY VIEW MEDICAL CENTER, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ5729111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ85456Medicare UPIN