Provider Demographics
NPI:1710930599
Name:APACHE OXY-MED INC
Entity Type:Organization
Organization Name:APACHE OXY-MED INC
Other - Org Name:DBA SUNRISE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TARIK
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHIRIF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-926-0133
Mailing Address - Street 1:105 N PASADENA ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-5013
Mailing Address - Country:US
Mailing Address - Phone:480-926-0133
Mailing Address - Fax:480-926-6377
Practice Address - Street 1:105 N PASADENA ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-5013
Practice Address - Country:US
Practice Address - Phone:480-926-0133
Practice Address - Fax:480-926-6377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ07259721332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0039710OtherBC/BS OF AZ
AZ923567Medicaid
AZ923567Medicaid