Provider Demographics
NPI:1093702367
Name:SUNSET MEDICAL CLINIC LLC
Entity Type:Organization
Organization Name:SUNSET MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:DAIGLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-662-7290
Mailing Address - Street 1:990 NAPOLEON AVENUE
Mailing Address - Street 2:
Mailing Address - City:SUNSET
Mailing Address - State:LA
Mailing Address - Zip Code:70584-6100
Mailing Address - Country:US
Mailing Address - Phone:337-662-7290
Mailing Address - Fax:
Practice Address - Street 1:990 NAPOLEON AVENUE
Practice Address - Street 2:
Practice Address - City:SUNSET
Practice Address - State:LA
Practice Address - Zip Code:70584-6100
Practice Address - Country:US
Practice Address - Phone:337-662-7290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1943142Medicaid
LA5847020001Medicare NSC
LA5D278Medicare ID - Type Unspecified