Provider Demographics
NPI:1316257967
Name:SUNRISE FAMILY CARE CLINIC SC
Entity type:Organization
Organization Name:SUNRISE FAMILY CARE CLINIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRACTIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDWEHR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:715-726-3096
Mailing Address - Street 1:2829 COUNTY HIGHWAY I
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729
Mailing Address - Country:US
Mailing Address - Phone:715-726-3096
Mailing Address - Fax:715-726-3979
Practice Address - Street 1:2829 COUNTY HIGHWAY I
Practice Address - Street 2:SUITE 2
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729
Practice Address - Country:US
Practice Address - Phone:715-726-3096
Practice Address - Fax:715-726-3979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45925-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty