Provider Demographics
NPI:1508583717
Name:SUNRISE MEDICAL TRANSPORTATION LLC
Entity Type:Organization
Organization Name:SUNRISE MEDICAL TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PROVIDENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:UWIMANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-559-9334
Mailing Address - Street 1:1875 WATERSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-7500
Mailing Address - Country:US
Mailing Address - Phone:937-559-9334
Mailing Address - Fax:
Practice Address - Street 1:1875 WATERSTONE BLVD
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-7500
Practice Address - Country:US
Practice Address - Phone:937-559-9334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)