| Sunrise Family Practice Llc | |
|
8785 S Jordan Valley Way # 100 West Jordan UT 84088-9772 | |
| (385) 645-7474 | |
| Not Available |
| Full Name | Sunrise Family Practice Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 8785 S Jordan Valley Way # 100, West Jordan, Utah |
| Authorized Official Name and Position | Jololene Allan (OWNER) |
| Authorized Official Contact | 3856457474 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sunrise Family Practice Llc 8785 S Jordan Valley Way # 100 West Jordan UT 84088-9772 Ph: () - | Sunrise Family Practice Llc 8785 S Jordan Valley Way # 100 West Jordan UT 84088-9772 Ph: (385) 645-7474 |
| NPI Number | 1386135762 |
|---|---|
| Provider Enumeration Date | 05/22/2018 |
| Last Update Date | 02/14/2019 |
| Medicare PECOS PAC ID | 8820337843 |
|---|---|
| Medicare Enrollment ID | O20190308000394 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386135762 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 211972-4405 (Utah) | Primary |
| Provider Name | Jololene Allan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316017627 PECOS PAC ID: 5890608210 Enrollment ID: I20031111000285 |
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