Provider Demographics
NPI:1558306977
Name:SUN CITY MEDICAL PRACTICE, P.A.
Entity Type:Organization
Organization Name:SUN CITY MEDICAL PRACTICE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ISSAC
Authorized Official - Middle Name:
Authorized Official - Last Name:BELBEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-225-0410
Mailing Address - Street 1:1700 N OREGON ST
Mailing Address - Street 2:SUITE 630
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3584
Mailing Address - Country:US
Mailing Address - Phone:915-225-0410
Mailing Address - Fax:915-225-0419
Practice Address - Street 1:2931 MONTANA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-2409
Practice Address - Country:US
Practice Address - Phone:915-562-4246
Practice Address - Fax:915-564-0667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1771479Medicaid
00644ZMedicare ID - Type Unspecified