Provider Demographics
NPI:1164665782
Name:SUNSET MEDICAL GROUP
Entity Type:Organization
Organization Name:SUNSET MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:GELMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-803-0717
Mailing Address - Street 1:901 TOWN CENTRE BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-2181
Mailing Address - Country:US
Mailing Address - Phone:800-803-0717
Mailing Address - Fax:
Practice Address - Street 1:901 TOWN CENTRE BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-2181
Practice Address - Country:US
Practice Address - Phone:800-803-0717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty