Provider Demographics
NPI:1134287238
Name:SUNSHINE MEDICAL, LLC
Entity type:Organization
Organization Name:SUNSHINE MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:FIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-454-0919
Mailing Address - Street 1:3021 S 35TH ST
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034-7236
Mailing Address - Country:US
Mailing Address - Phone:602-454-0919
Mailing Address - Fax:602-454-7919
Practice Address - Street 1:3021 S 35TH ST
Practice Address - Street 2:SUITE B-1
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-7236
Practice Address - Country:US
Practice Address - Phone:602-454-0919
Practice Address - Fax:602-454-7919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ05006604332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ076380Medicaid
AZ076380Medicaid