Provider Demographics
NPI:1659541118
Name:SUN HEALTH MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:SUN HEALTH MEDICAL GROUP, LLC
Other - Org Name:SUN HEALTH GERIATRIC PHYSICIAN ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:SELLNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-876-6616
Mailing Address - Street 1:PO BOX 1278
Mailing Address - Street 2:ATTN: MINDY OGDEN
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85372-1278
Mailing Address - Country:US
Mailing Address - Phone:623-544-5075
Mailing Address - Fax:623-544-5093
Practice Address - Street 1:10515 W SANTA FE DR
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3020
Practice Address - Country:US
Practice Address - Phone:623-815-7661
Practice Address - Fax:623-815-2981
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUN HEALTH CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty