Organization
PEACEHEALTH
Active
Other names
St. John Medical Center-PeaceHealth Therapy and Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL CHARLES METCALF (CHIEF EXECUTIVE PHMG)
(360) 729-1743
Entity
Organization
Contact information
Practice address
TRIANGLE MALL SUITE 16 1015 OCEAN BEACH HWY, LONGVIEW, WA 98632
(360) 501-3750
(360) 501-3751
Mailing address
1115 SE 164TH AVE DEPT 358, VANCOUVER, WA 98683-8004
(360) 729-1462
(360) 729-3104
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
WA
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
WA
Other
Enumeration date
09/04/2018
Last updated
09/04/2018
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