Basic Information
Provider Information
NPI: 1154790020
EntityType: 2
ReplacementNPI:  
OrganizationName: SUNNYSIDE COMMUNITY HOSPITAL
LastName:  
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Mailing Information
Address1: PO BOX 719
Address2:  
City: SUNNYSIDE
State: WA
PostalCode: 989440719
CountryCode: US
TelephoneNumber: 5098371500
FaxNumber:  
Practice Location
Address1: 1016 TACOMA AVE
Address2:  
City: SUNNYSIDE
State: WA
PostalCode: 989442263
CountryCode: US
TelephoneNumber: 5098371500
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/21/2015
LastUpdateDate: 09/21/2015
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: SMEENK
AuthorizedOfficialFirstName: FAITH
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CLINICAL INFORMATICS RN
AuthorizedOfficialTelephone: 5098371349
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MRS.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: RN
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
282NC0060X  Y HospitalsGeneral Acute Care HospitalCritical Access

ID Information
IDTypeStateIssuerDescription
122503381401WANATIONAL PROVIDER IDENTIFIEROTHER


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