Provider Demographics
NPI:1992881668
Name:SUN CITY ORTHOPEDICS
Entity type:Organization
Organization Name:SUN CITY ORTHOPEDICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:DRENNAN
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-532-3592
Mailing Address - Street 1:3233 N MESA ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2337
Mailing Address - Country:US
Mailing Address - Phone:915-532-3592
Mailing Address - Fax:915-532-3582
Practice Address - Street 1:3233 N MESA ST
Practice Address - Street 2:SUITE 205
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2337
Practice Address - Country:US
Practice Address - Phone:915-532-3592
Practice Address - Fax:915-532-3582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN/A332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4782420001Medicare NSC