Provider Demographics
NPI:1295420412
Name:SUNSHINE CLINIC
Entity type:Organization
Organization Name:SUNSHINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-265-3076
Mailing Address - Street 1:PO BOX 2201
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35502-2201
Mailing Address - Country:US
Mailing Address - Phone:205-265-3076
Mailing Address - Fax:205-265-2235
Practice Address - Street 1:4330 HIGHWAY 78 E STE 105
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-8955
Practice Address - Country:US
Practice Address - Phone:205-265-3076
Practice Address - Fax:205-265-2235
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNSHINE CLINIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-05
Last Update Date:2024-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty