Healthcare Provider Details

I. General information

NPI: 1679521637
Provider Name (Legal Business Name): SUNNYSIDE COMMUNITY HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 E LINCOLN AVE
SUNNYSIDE WA
98944-2383
US

IV. Provider business mailing address

PO BOX 719
SUNNYSIDE WA
98944-0719
US

V. Phone/Fax

Practice location:
  • Phone: 509-837-6911
  • Fax: 509-837-6920
Mailing address:
  • Phone: 509-837-6911
  • Fax: 509-837-6920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberHAC.FS.00000198
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberHAC.FS.00000198
License Number StateWA

VIII. Authorized Official

Name: MAXWELL OWENS
Title or Position: CFO
Credential:
Phone: 509-837-1617