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General NPI Number Information
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NPI Number | 1083866040
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Entity Type | Organization
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Legal Business Name | SUNNYSIDE COMMUNITY HOSPITAL
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 2925 ALLEN RD
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City | SUNNYSIDE
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State | WA
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Zip | 98944-8931
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Country | US
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Telephone | 509-837-1617
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Fax | 509-837-1714
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Provider Business Mailing Address
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Address Line | PO BOX 719
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City | SUNNYSIDE
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State | WA
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Zip | 98944-0719
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Country | US
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Telephone | 509-837-1617
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Fax | 509-837-1714
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Authorized Official
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Title or Position | CFO
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Name | MATHEW MATHIESEN
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Credential |
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Telephone | 509-837-1617
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MD60307626
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | MD60030905
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License Number State | WA
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