Provider Demographics
NPI:1477228385
Name:ACTIVE LIFE HEALTH OF SUN CITY PLLC
Entity Type:Organization
Organization Name:ACTIVE LIFE HEALTH OF SUN CITY PLLC
Other - Org Name:ARTHRITIS KNEE PAIN CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-444-2545
Mailing Address - Street 1:10503 W THUNDERBIRD BLVD STE 366A
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-2721
Mailing Address - Country:US
Mailing Address - Phone:623-444-2545
Mailing Address - Fax:
Practice Address - Street 1:10503 W THUNDERBIRD BLVD STE 302
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3022
Practice Address - Country:US
Practice Address - Phone:623-444-2545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-12
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies