Provider Demographics
NPI:1093964959
Name:SUNSET COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:SUNSET COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:A/R MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHAUNNA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIS
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:928-819-8804
Mailing Address - Street 1:2060 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6123
Mailing Address - Country:US
Mailing Address - Phone:928-819-8812
Mailing Address - Fax:928-539-5579
Practice Address - Street 1:2060 W 24TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6123
Practice Address - Country:US
Practice Address - Phone:928-819-8812
Practice Address - Fax:928-539-5579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC 3908207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ433061Medicaid
Z21116Medicare Oscar/Certification
031806Medicare Oscar/Certification
031822Medicare Oscar/Certification
Z21113Medicare Oscar/Certification
Z21130Medicare Oscar/Certification
Z21115Medicare Oscar/Certification
031823Medicare Oscar/Certification
031805Medicare Oscar/Certification
Z21114Medicare Oscar/Certification
031824Medicare Oscar/Certification