Organization
PEACEHEALTH
Active
Organization
PEACEHEALTH
Active
Other names
St. John Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS HAYWOOD (NETWORK CFO)
(360) 414-2173
Entity
Organization
Contact information
Practice address
600 BROADWAY ST, LONGVIEW, WA 98632-3256
(360) 414-2000
Mailing address
1115 SE 164TH AVE, DEPT 364, VANCOUVER, WA 98683-9324
(360) 414-2000
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
H-026
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3304508
—
WA
01
—
600521489
UBI
WA
01
—
H-026
DOH LICENSE #
WA
Enumeration date
09/29/2006
Last updated
07/12/2013
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