1689671984 NPI number — SUNNYSIDE COMMUNITY HOSPITAL ASSOCIATION

Table of content: (NPI 1689671984)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689671984 NPI number — SUNNYSIDE COMMUNITY HOSPITAL ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNNYSIDE COMMUNITY HOSPITAL ASSOCIATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ASTRIA HEALTH CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689671984
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 510
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUNNYSIDE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98944-0510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-882-1855
Provider Business Mailing Address Fax Number:
509-882-4998

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
208 N EUCLID RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANDVIEW
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98930-9470
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-882-1855
Provider Business Practice Location Address Fax Number:
509-882-4998
Provider Enumeration Date:
06/30/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LAWSON
Authorized Official First Name:
KIM
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS OFFICE MANAGER
Authorized Official Telephone Number:
509-837-1617

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RS0012X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X , with the licence number: 601650238 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 50-8540 . This is a "MEDICARE PART A" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7130727 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7071632 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".