Provider Demographics
NPI:1790041051
Name:SUNSHINE SPECIALTY CLINIC, PLLC
Entity Type:Organization
Organization Name:SUNSHINE SPECIALTY CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-484-9538
Mailing Address - Street 1:194 CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-4853
Mailing Address - Country:US
Mailing Address - Phone:931-484-9538
Mailing Address - Fax:931-484-4831
Practice Address - Street 1:194 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-4853
Practice Address - Country:US
Practice Address - Phone:931-484-9538
Practice Address - Fax:931-484-4831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-11
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21710207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3063949Medicare PIN