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Organization
SUNNYSIDE EMERGENCY GROUP A PROFESSIONAL LLC
Active
Organization
SUNNYSIDE EMERGENCY GROUP A PROFESSIONAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN R NICHOLS MD (PRESIDENT)
(800) 893-9698
Entity
Organization
Contact information
Practice address
1016 TACOMA AVE, SUNNYSIDE, WA 98944-2263
(800) 893-9698
Mailing address
200 CORPORATE BLVD, LAFAYETTE, LA 70508-3870
(800) 893-9698
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2038337
—
WA
01
—
G8928747
MEDICARE PIN
WA
Enumeration date
05/08/2014
Last updated
03/23/2022
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