NPIMap

Organization Active NPI

Cowlitz Family Health Center

Doing business as Family Health Center 14th Ave

  • Federally Qualified Health Center (FQHC)
  • Longview, WA
National Provider Identifier
1962876748
Registry record updated May 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
600176084 Issued in WA
Legal business name
COWLITZ FAMILY HEALTH CENTER
Doing business as
Family Health Center 14th Ave
Practice address
784 14TH Ave
Longview, WA 98632-2315
Phone
(360) 703-6400
Fax
(360) 353-3611
NPI assigned
Nov 17, 2015
Last updated
May 31, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
COWLITZ FAMILY HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 31, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
James K Coffee
Title
Ceo
Phone
(360) 636-3892

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Surgical Family Planning Clinic/Center 261QF0050X 600176084 WA
Federally Qualified Health Center (FQHC) 261QF0400X 600176084 WA Primary
Adult Mental Health Clinic/Center 261QM0850X 600176084 WA
Adolescent and Children Mental Health Clinic/Center 261QM0855X 600176084 WA
Primary Care Clinic/Center 261QP2300X 600176084 WA

Addresses

Primary practice location

784 14TH Ave
Longview, WA 98632-2315

Mailing address

1057 12TH Ave
Longview, WA 98632-2509
Phone (360) 636-3892

Other names 1

  • Family Health Center 14th Ave Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040324000330 WA Part B Supplier - Clinic/Group Practice 5991696395 Receives reassigned benefits from 19 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Castle Rock, WA; Cathlamet, WA; Kelso, WA; Longview, WA; Ocean Park, WA; Woodland, WA
O20161221001216 WA Part A Provider - Federally Qualified Health Center (FQHC) 5991696395 Practice locations: Longview, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1962876748. Details of each certification follow.

Federally qualified health center certification: CCN 941018

Legal name
COWLITZ FAMILY HEALTH CENTER
Doing business as
FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 14, 2016
Last certification
Dec 14, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 28, 1973 in WA
Enrollment address
784 14TH Ave
Longview, WA 98632-2315

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
NB North Beach Clinic14 organizations share this tax ID, including this one
Part of
NB North Beach Clinic

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Locations

300 Oak St
Ste B
Kelso, WA 98626
Phone (360) 353-5511

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Wanda M McBee Individual Corporate OfficerBoard Secretary Sep 22, 2016
James Coffee Individual Corporate OfficerCeo Dec 1, 2020
W-2 Managing EmployeeCeo Dec 1, 2020
Cynthia L Washington-Mattson Individual Corporate OfficerBoard Vice President Sep 22, 2016
Mark Nelson Individual Corporate OfficerBoard President Dec 4, 2019

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1447718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653955200000",
    "number": "1962876748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1057 12TH AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322509",
            "telephone_number": "360-636-3892",
            "fax_number": "360-232-8400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "784 14TH AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322315",
            "telephone_number": "360-703-6400",
            "fax_number": "360-353-3611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COWLITZ FAMILY HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COWLITZ FAMILY HEALTH CENTER",
        "enumeration_date": "2015-11-17",
        "last_updated": "2022-05-31",
        "certification_date": "2022-05-31",
        "status": "A",
        "authorized_official_last_name": "COFFEE",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "360-636-3892"
    },
    "taxonomies": [
        {
            "code": "261QF0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Family Planning, Non-Surgical",
            "state": "WA",
            "license": "600176084",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "WA",
            "license": "600176084",
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "WA",
            "license": "600176084",
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "WA",
            "license": "600176084",
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "WA",
            "license": "600176084",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Health Center 14th Ave",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Health Center 14th Ave",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Longview, WA

Sources for this page

Verify at the official NPI Registry.