MEDICARE: SHC MEDICAL CENTER TOPPENISH

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	207Q00000X	Family Medicine Physician	600581630	WA
2	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1659809457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHC MEDICAL CENTER TOPPENISH

Provider Business Mailing Address
First Line	:	PO BOX 719
Second Line	:
City	:	SUNNYSIDE
State	:	WA
Zip	:	98944-0719
Country	:	US
Telephone Number	:	509-837-1617
Fax Number	:

Provider Business Practice Location Address
First Line	:	915 VINTAGE VALLEY PKWY STE 200
Second Line	:
City	:	ZILLAH
State	:	WA
Zip	:	98953-9800
Country	:	US
Telephone Number	:	509-829-5151
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MATHEW MATHIESEN
Credential	:
Telephone Number	:	509-837-1379

Provider Enumeration Date	:	05/24/2017
Last Update Date	:	10/09/2024

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Directions to “SHC MEDICAL CENTER TOPPENISH ” Practice Location

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