SUNRISE PRIMARY CARE INC (NPI# 1073642419) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073642419 |
| Entity Type | Organization |
| Organization Name | SUNRISE PRIMARY CARE INC |
| Other Organization Name | SUNRISE PRIMARY CARE INC |
| Practice Address |
219 N Palm Ave Palatka FL 32177-2627 |
| Mailing Address |
Po Box 249 Palatka FL 32178-0249 |
| Practice Telephone | 3863258002 |
| Practice Fax Number | 3863258055 |
| Mailing Telephone | 3863258002 |
| Mailing Fax Number | 3863258055 |
| Enumeration Date | 2007-03-03 |
| Last Update Date | 2012-07-12 |
| Authorized Official Name | DR. MARIA-JOSEFINA S RIVERA (PRES) |
| Authorized Official Telephone | 3863258002 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | ME 76342 | FL | Allopathic & Osteopathic Physicians |
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
ME 76342 | FL | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 660236300 | 05 |
| Other Name | Type Code |
|---|---|
| Sunrise Primary Care INC | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437104916 | Sunrise Primary Care Inc | Clinic/Center | 811 North Summit St, Crescent City, FL 32112-2407 | 2006-05-23 |
| 1124294012 | Sunrise Primary Care Inc | Family Medicine | 811 N Summit St, Crescent City, FL 32112-2109 | 2008-05-01 |
| 1891984415 | Sunrise Primary Care Inc | Family Medicine | 811 N Summit St, Crescent City, FL 32112-2109 | 2007-10-19 |
| 1346439965 | Sunrise Primary Care Inc | Family Medicine | 811 N Summit St, Crescent City, FL 32112-2109 | 2007-10-19 |
| 1568593937 | Sunrise Primary Care Inc | Family Medicine | 219 N Palm Ave, Palatka, FL 32177-2627 | 2007-03-08 |
| Street Address |
219 N PALM AVE |
| City | PALATKA |
| State | FL |
| Zip Code | 32177-2627 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568593937 | Sunrise Primary Care Inc | Family Medicine | 219 N Palm Ave, Palatka, FL 32177-2627 | 2007-03-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174124176 | Charlie Douglas | Pharmacist | 1024 South State Road 19, Pharmacy, Palatka, FL 32177 | 2020-11-05 |
| 1275090359 | Carol M Kazounis | Dietitian, Registered | 2801 Kennedy Strett, Palatka, FL 32177 | 2019-02-26 |
| 1447744768 | Pulido Internal Medicine | Nurse Practitioner | 700 Zeagler Drive, Suite 1, Palatka, FL 32177 | 2018-06-20 |
| 1063922656 | Ronald Michael Wendt | Nurse Practitioner | 3703 Crill Ave, Palatka, FL 32177 | 2017-10-09 |
| 1043560212 | Leslie Ann Lewis | Massage Therapist | 325 Poinsetta Ave, Palatka, FL 32177 | 2012-09-14 |
| 1285984963 | Walgreens | Pharmacy | 719 South State Road 19, Palatka, FL 32177 | 2012-09-11 |
| 1841549235 | Audrey M Russell | Pharmacy Technician | 719 Hwy 19 South, Palatka, FL 32177 | 2012-08-31 |
| 1194023838 | Sherry D. Michael | Licensed Practical Nurse | 330 Kay Larkin Dr., Palatka, FL 32177 | 2011-03-04 |
| 1083846364 | Patricia Kowalchuk | Occupational Therapy Assistant | 6050 St.johns Ave., Suite A, Palatka, FL 32177 | 2009-08-20 |
| 1609015320 | Robin Calhoun | Occupational Therapist | 611 Zeagler Dr., Palatka, FL 32177 | 2009-02-19 |
| Find all providers in zip 32177 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083913842 | Family Practice,dr.assefa LLC | Clinic/Center | 6100 Saint Johns Ave Ste 4, Palatka, FL 32177-6859 | 2011-03-19 |
| 1174892830 | Medex Primary Care | Clinic/Center | 6500 Crill Ave, Bldg 3 Ste 1, Palatka, FL 32177-9230 | 2011-12-23 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.