# PEACEHEALTH MEDICAL GROUP - SEDRO WOOLLEY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PeaceHealth Medical Group - Sedro Woolley
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407283179
- **Authorized official:** MR. KIMBERLY A HODGKINSON (EVP CFO)
- **Authorized official phone:** (360) 729-1145

## Contact information

- **Practice address:** 1990 HOSPITAL DR, SEDRO WOOLLEY, WA 98284
- **Practice address phone:** (360) 856-8810
- **Practice address fax:** (360) 714-2520
- **Mailing address:** 1115 SE 164TH AVE DEPT 358, VANCOUVER, WA 98683-8004
- **Mailing address phone:** (360) 729-1411
- **Mailing address fax:** (360) 501-7535

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/26/2013
- **Last updated:** 08/21/2018