Provider Demographics
NPI:1760601462
Name:ZIA SUN INC
Entity Type:Organization
Organization Name:ZIA SUN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-443-6262
Mailing Address - Street 1:1909 CUBA AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-5646
Mailing Address - Country:US
Mailing Address - Phone:505-443-6262
Mailing Address - Fax:505-443-0672
Practice Address - Street 1:1909 CUBA AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-5646
Practice Address - Country:US
Practice Address - Phone:505-443-6262
Practice Address - Fax:505-443-0672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM86069174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM37804Medicaid
NM100521009Medicare ID - Type Unspecified
NMD24754Medicare UPIN