Provider Demographics
NPI:1447203104
Name:MID-VALLEY COMMUNITY CLINIC, PLLC
Entity Type:Organization
Organization Name:MID-VALLEY COMMUNITY CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HARLAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HALMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-839-6822
Mailing Address - Street 1:PO BOX 957
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944-0957
Mailing Address - Country:US
Mailing Address - Phone:509-839-6822
Mailing Address - Fax:509-839-5913
Practice Address - Street 1:700 S 11TH ST
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-2243
Practice Address - Country:US
Practice Address - Phone:509-839-6822
Practice Address - Fax:509-839-5913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601689666207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8283707Medicaid
WAMD00026187OtherDR WRUNG STATE LICENSE
WAMD00032042OtherDR HALMA STATE LICENSE
WA1052273Medicaid
WAOP00000839OtherDR. SWOFFORD STATE LICENS
WA8156861Medicaid
WA7075070Medicaid
WAF49187Medicare UPIN
WA7075070Medicaid
WA1052273Medicaid
WA115140705Medicare ID - Type UnspecifiedDR WRUNG MEDICARE
WA115140704Medicare ID - Type UnspecifiedDR SWOFFORD-MEDICARE
WAMD00032042OtherDR HALMA STATE LICENSE
WAMD00026187OtherDR WRUNG STATE LICENSE
WAB42862Medicare UPIN