Provider Demographics
NPI:1568579977
Name:SUNRISE FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:SUNRISE FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SEELY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-620-9111
Mailing Address - Street 1:991 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLANTSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06479-1627
Mailing Address - Country:US
Mailing Address - Phone:860-620-9111
Mailing Address - Fax:860-276-9801
Practice Address - Street 1:991 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PLANTSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06479-1627
Practice Address - Country:US
Practice Address - Phone:860-620-9111
Practice Address - Fax:860-276-9801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040594261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID #