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General NPI Number Information
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NPI Number | 1447203104
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Entity Type | Organization
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Legal Business Name | MID-VALLEY COMMUNITY CLINIC, PLLC
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 04/25/2011
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Provider Practice Location Address
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Address Line | 700 S 11TH ST
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City | SUNNYSIDE
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State | WA
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Zip | 98944-2243
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Country | US
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Telephone | 509-839-6822
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Fax | 509-839-5913
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Provider Business Mailing Address
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Address Line | PO BOX 957
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City | SUNNYSIDE
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State | WA
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Zip | 98944-0957
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Country | US
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Telephone | 509-839-6822
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Fax | 509-839-5913
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | HARLAN D. HALMA
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Credential | M.D.
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Telephone | 509-839-6822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 601689666
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License Number State | WA
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