Provider Demographics
NPI:1528589306
Name:SUNRISE MEDICAL GROUP CORPORATION
Entity Type:Organization
Organization Name:SUNRISE MEDICAL GROUP CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-868-1001
Mailing Address - Street 1:486 W 165 S
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-5360
Mailing Address - Country:US
Mailing Address - Phone:435-868-1001
Mailing Address - Fax:
Practice Address - Street 1:1152 E GREENWAY ST STE 5
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-4360
Practice Address - Country:US
Practice Address - Phone:435-868-1001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-30
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies