Healthcare Provider Details

I. General information

NPI: 1871986455
Provider Name (Legal Business Name): SUNNYSIDE COMMUNITY HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2015
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 MILLER AVE
SUNNYSIDE WA
98944-2374
US

IV. Provider business mailing address

PO BOX 719
SUNNYSIDE WA
98944-0719
US

V. Phone/Fax

Practice location:
  • Phone: 509-836-4825
  • Fax: 509-837-4908
Mailing address:
  • Phone: 509-836-4825
  • Fax: 509-837-4908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. KIM LAWSON
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 509-837-1617