Provider Demographics
NPI:1619964533
Name:SUN COUNTRY MEDICAL EQUIPMENT, INC
Entity Type:Organization
Organization Name:SUN COUNTRY MEDICAL EQUIPMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YASSER
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYDAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-592-4346
Mailing Address - Street 1:2019 E MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-3504
Mailing Address - Country:US
Mailing Address - Phone:915-592-4346
Mailing Address - Fax:915-592-4369
Practice Address - Street 1:2019 E MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-3504
Practice Address - Country:US
Practice Address - Phone:915-592-4346
Practice Address - Fax:915-592-4369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0031287332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX015986501Medicaid
TX087206101Medicaid
TX087206101Medicaid
TXC08415598Medicare ID - Type UnspecifiedSUBMITTER ID