Active NPI
Peacehealth
Doing business as PeaceHealth Longview Urology
- Urology Physician
- Longview, WA
National Provider Identifier
1255977591
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- Legal business name
- PEACEHEALTH
- Doing business as
- PeaceHealth Longview Urology
- Practice address
- 625 9TH Ave Ste 120
Longview, WA 98632-2465 - Phone
- (360) 636-8950
- Fax
- (360) 636-8951
- NPI assigned
- Nov 21, 2019
- Last updated
- Nov 27, 2019
- Organization subpart
- Yes
- Parent organization
- PEACEHEALTH
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Michael Charles Metcalf
- Title
- Chief Executive PHMG
- Phone
- (360) 729-1743
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | NU | ||
| Urology Physician | 208800000X | NU | Primary |
Addresses
Primary practice location
625 9TH Ave Ste 120
Longview, WA 98632-2465
Mailing address
1115 SE 164TH Ave Dept 358
Vancouver, WA 98683-8004
Phone (360) 729-1462
Other names 1
- PeaceHealth Longview Urology
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200210000931 | WA | DME Supplier - Physician - Urology | 5890689293 | Practice locations: Longview, WA |
Other NPIs with the same Medicare PAC ID 4
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
dba St. John Medical Center
- General Acute Care Hospital
- Longview, WA
- NPI 1073510277
5890689293
-
dba St. John Medical Center-PeaceHealth Therapy and Wellness
- Prosthetic/Orthotic Supplier
- Longview, WA
- NPI 1184106437
5890689293
-
dba St. John Medical Center - PeaceHealth Medical Group
- Multi-Specialty Clinic/Center
- Longview, WA
- NPI 1720056187
5890689293
-
dba St John Medical Center - PeaceHealth Medical Group
- Durable Medical Equipment & Medical Supplies
- Longview, WA
- NPI 1801909171
5890689293
National Provider Directory
National Provider Directory- Tax ID family
- PH Behaviroal Health
- Part of
- PH Behaviroal Health
Other organizations with this tax ID 5
Organizations that report the same tax identification number in the National Provider Directory.
-
dba St. John Medical Center-PeaceHealth Therapy and Wellness
- Prosthetic/Orthotic Supplier
- Longview, WA
- NPI 1184106437
-
dba St. John Medical Center
- Durable Medical Equipment & Medical Supplies
- Longview, WA
- NPI 1639285539
-
dba St John Medical Center - PeaceHealth Medical Group
- Durable Medical Equipment & Medical Supplies
- Longview, WA
- NPI 1801909171
-
dba PeaceHealth St John Medical Center Pharmacy
- Community/Retail Pharmacy
- Longview, WA
- NPI 1811252687
-
- Pharmacotherapy Pharmacist
- Longview, WA
- NPI 1205043296
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
-
dba PeaceHealth Home Health of Whatcom County
- Home Health Agency
- Bellingham, WA
- NPI 1710639901
Member Of
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1574294400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1574812800000",
"number": "1255977591",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1115 SE 164TH AVE DEPT 358",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986838004",
"telephone_number": "360-729-1462",
"fax_number": "360-729-3104"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "625 9TH AVE STE 120",
"city": "LONGVIEW",
"state": "WA",
"postal_code": "986322465",
"telephone_number": "360-636-8950",
"fax_number": "360-636-8951"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PEACEHEALTH",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "PEACEHEALTH",
"enumeration_date": "2019-11-21",
"last_updated": "2019-11-27",
"status": "A",
"authorized_official_last_name": "METCALF",
"authorized_official_first_name": "MICHAEL",
"authorized_official_middle_name": "CHARLES",
"authorized_official_title_or_position": "CHIEF EXECUTIVE PHMG",
"authorized_official_telephone_number": "360-729-1743"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "PeaceHealth Longview Urology",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "PeaceHealth Longview Urology",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Longview, WA
- Michael Paulsen
- Peacehealth (St. John Medical Center)
- Peacehealth (St John Medical Center - Women's Health)
- Peacehealth (St. John Medical Center-PeaceHealth Therapy and Wellness)
- Peacehealth (St John Medical Center - PeaceHealth Medical Group Lakefront)
- Peacehealth (St. John Medical Center - Outpatient Therapy)
- Peacehealth
- Peacehealth (St John Medical Center - Occupational Health)
- Peacehealth (PeaceHealth St John Medical Center Retail Pharmacy)
- Peacehealth (St. John Medical Center)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.