Provider Demographics
NPI:1225569528
Name:SUN CITY MEDICAL CENTER PLLC
Entity Type:Organization
Organization Name:SUN CITY MEDICAL CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:702-300-8528
Mailing Address - Street 1:9280 W SUNSET RD STE 410
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4862
Mailing Address - Country:US
Mailing Address - Phone:702-300-8528
Mailing Address - Fax:702-447-7544
Practice Address - Street 1:9280 W SUNSET RD STE 410
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4862
Practice Address - Country:US
Practice Address - Phone:702-300-8528
Practice Address - Fax:702-447-7544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0904213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1649446220OtherNPI
NVBW174YMedicare PIN
NVBW174XMedicare PIN