Organization
SUN LIFE FAMILY HEALTH CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRAVIS ROBINETTE (CHIEF EXECUTIVE OFFICER)
(520) 836-3446
Entity
Organization
Contact information
Practice address
44572 WEST BOWLIN ROAD, MARICOPA, AZ 85139
(520) 568-2245
(520) 568-2316
Mailing address
PO BOX 10097, CASA GRANDE, AZ 85130-0020
(520) 836-3446
(520) 836-8807
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AZ04475
—
AZ
01
—
ZFQ31814
MEDICARE PTAN
—
Enumeration date
05/04/2007
Last updated
05/26/2020
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