Peacehealth

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

License

H-026 Issued in WA

Legal business name

PEACEHEALTH

Practice address

600 Broadway St
Longview, WA 98632-3256

Phone

(360) 414-2000

NPI assigned

Sep 29, 2006

Organization subpart

No

Name

Thomas Haywood

Title

Network Cfo

Phone

(360) 414-2173

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Peacehealth

  • Community Based Hospice Care Agency
  • Ketchikan, AK
  • NPI 1386362580

  Member Of

  NPD member

Locations

• St. John Medical Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 12, 2013.

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373587200000",
    "number": "1508958331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 SE 164TH AVE",
            "address_2": "DEPT 364",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986839324",
            "telephone_number": "360-414-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 BROADWAY ST",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986323256",
            "telephone_number": "360-414-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACEHEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-29",
        "last_updated": "2013-07-12",
        "status": "A",
        "authorized_official_last_name": "HAYWOOD",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "NETWORK CFO",
        "authorized_official_telephone_number": "360-414-2173"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "WA",
            "license": "H-026",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3304508",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UBI",
            "identifier": "600521489",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DOH LICENSE #",
            "identifier": "H-026",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. John Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Peacehealth
• Peacehealth
• Peacehealth
• Peacehealth
• Peacehealth
• Peacehealth
• Peacehealth
• Peacehealth
• Peacehealth
• Peacehealth

• All providers in Longview, WA
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.