Provider Demographics
NPI:1558026302
Name:SUNSHINE TELEMEDICINE
Entity Type:Organization
Organization Name:SUNSHINE TELEMEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-313-2273
Mailing Address - Street 1:805 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-3625
Mailing Address - Country:US
Mailing Address - Phone:208-238-0400
Mailing Address - Fax:208-238-0401
Practice Address - Street 1:805 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-3625
Practice Address - Country:US
Practice Address - Phone:208-238-0400
Practice Address - Fax:208-238-0401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-06
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty