Provider Demographics
NPI:1811280290
Name:SUNRISE COMPLEMENTARY MEDICAL CENTER
Entity type:Organization
Organization Name:SUNRISE COMPLEMENTARY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:WOELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:951-461-4800
Mailing Address - Street 1:750 NW CHARBONNEAU STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-0000
Mailing Address - Country:US
Mailing Address - Phone:951-461-4800
Mailing Address - Fax:
Practice Address - Street 1:750 NW CHARBONNEAU STREET #201
Practice Address - Street 2:SUITE 201
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-0000
Practice Address - Country:US
Practice Address - Phone:951-461-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSAL HEALTH ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-18
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208D00000X
CA20A7003207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty