Organization
PEACEHEALTH
Active
Other names
St John Medical Center - PeaceHealth Medical Group Lakefront
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS HAYWOOD (REGIONAL CFO)
(360) 414-2000
Entity
Organization
Contact information
Practice address
1718 E KESSLER BLVD, LONGVIEW, WA 98632-1842
(360) 747-5800
(360) 575-3846
Mailing address
PO BOX 3002, LONGVIEW, WA 98632-0302
(360) 414-2000
(360) 414-2054
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
09/27/2011
Last updated
09/27/2011
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