Provider Demographics
NPI:1306865597
Name:SUNRISE MEDICAL SUPLLY
Entity Type:Organization
Organization Name:SUNRISE MEDICAL SUPLLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:AKOMU
Authorized Official - Last Name:OMIJIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-866-1512
Mailing Address - Street 1:13041 N 35TH AVE
Mailing Address - Street 2:SUITE C-5
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-1230
Mailing Address - Country:US
Mailing Address - Phone:602-866-1512
Mailing Address - Fax:
Practice Address - Street 1:13041 N 35TH AVE
Practice Address - Street 2:SUITE C-5
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-1230
Practice Address - Country:US
Practice Address - Phone:602-866-1512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ=========OtherEIN