Provider Demographics
NPI:1073771721
Name:SUN MEADOW FAMILY MEDICINE INC
Entity Type:Organization
Organization Name:SUN MEADOW FAMILY MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-917-9208
Mailing Address - Street 1:1455 W CHANDLER BLVD
Mailing Address - Street 2:SUITE B-11
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6177
Mailing Address - Country:US
Mailing Address - Phone:480-917-9208
Mailing Address - Fax:480-814-7443
Practice Address - Street 1:1455 W CHANDLER BLVD
Practice Address - Street 2:SUITE B-11
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6177
Practice Address - Country:US
Practice Address - Phone:480-917-9208
Practice Address - Fax:480-814-7443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22101207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ178815Medicaid
AZF34557Medicare UPIN