Provider Demographics
NPI:1689807646
Name:SUNRISE MEDICAL SUPPLYAGENCY
Entity Type:Organization
Organization Name:SUNRISE MEDICAL SUPPLYAGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-561-0077
Mailing Address - Street 1:319 DARTMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-5438
Mailing Address - Country:US
Mailing Address - Phone:352-686-6483
Mailing Address - Fax:727-489-6884
Practice Address - Street 1:319 DARTMOUTH AVE
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-5438
Practice Address - Country:US
Practice Address - Phone:352-686-6483
Practice Address - Fax:727-489-6884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies