Provider Demographics
NPI:1356340624
Name:CITY OF SUNNYSIDE
Entity type:Organization
Organization Name:CITY OF SUNNYSIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE AND ADMIN SERVICES DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMISON
Authorized Official - Middle Name:K
Authorized Official - Last Name:HORNER
Authorized Official - Suffix:
Authorized Official - Credentials:CPC/CMA/HCA
Authorized Official - Phone:509-836-6392
Mailing Address - Street 1:513 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944-2275
Mailing Address - Country:US
Mailing Address - Phone:509-837-3999
Mailing Address - Fax:509-836-6419
Practice Address - Street 1:513 S 8TH ST
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944
Practice Address - Country:US
Practice Address - Phone:509-837-3999
Practice Address - Fax:509-836-6419
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF SUNNYSIDE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-19
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA39M063416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0059847OtherL & I
WA590005697OtherRR MEDICARE
WA9120312Medicaid
WAG00011956Medicare PIN