Provider Demographics
NPI:1376642363
Name:SUNRISE FAMILY PRACTICE PLLC
Entity Type:Organization
Organization Name:SUNRISE FAMILY PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:303-738-5808
Mailing Address - Street 1:10268 W CENTENNIAL RD
Mailing Address - Street 2:STE 104
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127
Mailing Address - Country:US
Mailing Address - Phone:303-738-5808
Mailing Address - Fax:
Practice Address - Street 1:10268 W CENTENNIAL RD
Practice Address - Street 2:STE 104
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127
Practice Address - Country:US
Practice Address - Phone:303-738-5808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41131207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO90170547Medicaid
CO90170547Medicaid