MEDICARE: SUNNYSIDE COMMUNITY HOSPITAL ASSOCIATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center
2	275N00000X	Medicare Defined Swing Bed Hospital Unit		WA
3	282NC0060X	Critical Access Hospital	600 581 630	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10250	OTHER	WA	LABOR & INDUSTRIES
2	SU9354	OTHER	WA	REGENCE BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	147	OTHER	WA	PREMERA BLUE CROSS

General Provider Information

NPI Number	:	1225033814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNNYSIDE COMMUNITY HOSPITAL ASSOCIATION

Provider Business Mailing Address
First Line	:	P.O. BOX 719
Second Line	:
City	:	SUNNYSIDE
State	:	WA
Zip	:	98944
Country	:	US
Telephone Number	:	509-837-1500
Fax Number	:	509-837-1533

Provider Business Practice Location Address
First Line	:	1016 TACOMA AVE
Second Line	:
City	:	SUNNYSIDE
State	:	WA
Zip	:	98944
Country	:	US
Telephone Number	:	509-837-1500
Fax Number	:	509-837-1533

Authorized Official
Title or Position	:	CFO
Name	:	MR. MATHEW MATHIESEN
Credential	:
Telephone Number	:	509-837-1655

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	10/10/2024

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Directions to “SUNNYSIDE COMMUNITY HOSPITAL ASSOCIATION ” Practice Location

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