Organization
PEACEHEALTH
Active
Organization
PEACEHEALTH
Active
Other names
St. John Medical Center - PeaceHealth Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS HAYWOOD (REGIONAL VP/CFO)
(360) 414-5797
Entity
Organization
Contact information
Practice address
1615 DELAWARE ST, LONGVIEW, WA 98632-2367
(360) 414-2000
(360) 414-2054
Mailing address
PO BOX 3002, LONGVIEW, WA 98632-0302
(360) 414-2000
(360) 414-2054
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
—
—
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
—
—
207L00000X
Anesthesiology Physician
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207RH0003X
Hematology & Oncology Physician
—
—
207RN0300X
Nephrology Physician
—
—
207RR0500X
Rheumatology Physician
—
—
207RX0202X
Medical Oncology Physician
—
—
208D00000X
General Practice Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
03/10/2006
Last updated
07/29/2011
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