Provider Demographics
NPI:1871986455
Name:SUNNYSIDE COMMUNITY HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:SUNNYSIDE COMMUNITY HOSPITAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-837-1617
Mailing Address - Street 1:PO BOX 719
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944-0719
Mailing Address - Country:US
Mailing Address - Phone:509-836-4825
Mailing Address - Fax:509-837-4908
Practice Address - Street 1:812 MILLER AVE
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-2374
Practice Address - Country:US
Practice Address - Phone:509-836-4825
Practice Address - Fax:509-837-4908
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNNYSIDE CARDIOLOGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-06
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty