Basic Information
| Provider Information | |||||||||
| NPI: | 1831369396 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUN HEALTH RESEARCH INSTITUTE | ||||||||
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| OtherOrganizationName: | SUN HEALTH NEUROSCIENCE ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1278 | ||||||||
| Address2: | STTN: MINDY OGDEN | ||||||||
| City: | SUN CITY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853721278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235445075 | ||||||||
| FaxNumber: | 6235445093 | ||||||||
| Practice Location | |||||||||
| Address1: | 10515 W SANTA FE DR | ||||||||
| Address2: | |||||||||
| City: | SUN CITY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853513020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6238756530 | ||||||||
| FaxNumber: | 6238756504 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2008 | ||||||||
| LastUpdateDate: | 04/29/2008 | ||||||||
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| AuthorizedOfficialLastName: | CAMP | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6238765605 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 103TC0700X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical | 2084N0400X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.