Provider Demographics
NPI:1245283597
Name:SUN HEALTH LAKES IMAGING CENTER
Entity type:Organization
Organization Name:SUN HEALTH LAKES IMAGING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-876-5356
Mailing Address - Street 1:PO BOX 5430
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85376-5430
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10474 W THUNDERBIRD BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3015
Practice Address - Country:US
Practice Address - Phone:623-876-5351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC-3641261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5500000S0215OtherTMG
AZP00160563OtherLAKES MEDICARE RR (216)
AZ2Z1539OtherHEALTH NET
AZAZ0761130OtherBCBSAZ
AZ898190Medicaid
AZZ79719Medicare ID - Type UnspecifiedMEDICARE (888 213)