Organization
PEACEHEALTH
Active
Other names
St John Medical Center - PeaceHealth Medical Group Ocean Beach
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TOM HAYWOOD (NETWORK CFO)
(360) 414-2000
Entity
Organization
Contact information
Practice address
812 OCEAN BEACH HWY, STE. 200, LONGVIEW, WA 98632-4082
(360) 636-6900
Mailing address
1115 SE 164TH AVE, DEPT. 364, VANCOUVER, WA 98683-9324
(360) 414-2000
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
04/28/2010
Last updated
09/13/2013
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