Provider Demographics
NPI:1073493359
Name:MOUNTAIN SUN MEDICAL, PLLC
Entity type:Organization
Organization Name:MOUNTAIN SUN MEDICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TENURED PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BINNEBOESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-796-2641
Mailing Address - Street 1:1240B E STRINGHAM AVE STE 1034
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2490
Mailing Address - Country:US
Mailing Address - Phone:801-796-2641
Mailing Address - Fax:205-891-1270
Practice Address - Street 1:1240 E STRINGHAM AVE STE 1034
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2560
Practice Address - Country:US
Practice Address - Phone:801-796-2641
Practice Address - Fax:205-891-1270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health