Provider Demographics
NPI:1689843872
Name:SUN HEALTH MEDICAL GROUP LLC
Entity type:Organization
Organization Name:SUN HEALTH MEDICAL GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, PHYSICIAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:R
Authorized Official - Last Name:BROSOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-544-5079
Mailing Address - Street 1:PO BOX 1278
Mailing Address - Street 2:ATTN: MINDY OGDEN
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85372-1278
Mailing Address - Country:US
Mailing Address - Phone:623-544-5075
Mailing Address - Fax:623-544-5093
Practice Address - Street 1:1395 W WICKENBURG WAY
Practice Address - Street 2:
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-4231
Practice Address - Country:US
Practice Address - Phone:623-388-9957
Practice Address - Fax:928-684-7457
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUN HEALTH CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty