Provider Demographics
NPI:1497107882
Name:SUNNYSIDE COMMUNITY HOSPITAL OUTPATIENT CENTER 5
Entity Type:Organization
Organization Name:SUNNYSIDE COMMUNITY HOSPITAL OUTPATIENT CENTER 5
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEDBETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-335-4715
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:509-573-3530
Mailing Address - Fax:509-573-3535
Practice Address - Street 1:6101 SUMMITVIEW AVE
Practice Address - Street 2:STE 200
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3048
Practice Address - Country:US
Practice Address - Phone:509-573-3530
Practice Address - Fax:509-573-3535
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNNYSIDE COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center