Provider Demographics
NPI:1649663030
Name:SUNESIS COMPREHENSIVE CARE, PLLC
Entity type:Organization
Organization Name:SUNESIS COMPREHENSIVE CARE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LATICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:THARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:910-865-5177
Mailing Address - Street 1:122 E BLUE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAULS
Mailing Address - State:NC
Mailing Address - Zip Code:28384-1812
Mailing Address - Country:US
Mailing Address - Phone:910-865-5177
Mailing Address - Fax:910-865-9400
Practice Address - Street 1:122 E BLUE ST
Practice Address - Street 2:
Practice Address - City:SAINT PAULS
Practice Address - State:NC
Practice Address - Zip Code:28384-1812
Practice Address - Country:US
Practice Address - Phone:910-865-5177
Practice Address - Fax:910-865-9400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-10
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5000713261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1184694960OtherNPI
NC2592580OtherPTAN
NC7004391Medicaid
NC2592580OtherPTAN