Provider Demographics
NPI:1821079955
Name:SUNRISE MEDICAL CENTER S. C.
Entity Type:Organization
Organization Name:SUNRISE MEDICAL CENTER S. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-633-8300
Mailing Address - Street 1:16750 80TH AVE
Mailing Address - Street 2:STE D
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-3173
Mailing Address - Country:US
Mailing Address - Phone:708-633-8300
Mailing Address - Fax:708-633-8091
Practice Address - Street 1:16750 80TH AVE
Practice Address - Street 2:STE D
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-3173
Practice Address - Country:US
Practice Address - Phone:708-633-8300
Practice Address - Fax:708-633-8091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360908461Medicaid
ILG41930Medicare UPIN
IL206693Medicare ID - Type Unspecified