Provider Demographics
NPI:1558445247
Name:SUNRISE MEDICAL MANAGEMENT, INC
Entity Type:Organization
Organization Name:SUNRISE MEDICAL MANAGEMENT, INC
Other - Org Name:MINDEN MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:PROUTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-382-1332
Mailing Address - Street 1:603 FLEMING LN
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055-3073
Mailing Address - Country:US
Mailing Address - Phone:318-382-1332
Mailing Address - Fax:318-377-6893
Practice Address - Street 1:603 FLEMING LN
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-3073
Practice Address - Country:US
Practice Address - Phone:318-382-1332
Practice Address - Fax:318-377-6893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1348856Medicaid
LA1348856Medicaid