PEACEHEALTH SOUTHWEST MEDICAL CENTER (NPI# 1003194911) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003194911 |
| Entity Type | Organization |
| Organization Name | PEACEHEALTH SOUTHWEST MEDICAL CENTER |
| Other Organization Name | PEACEHEALTH SW HEART & VASCULAR CENTER |
| Practice Address |
200 Ne Mother Joseph Pl Ste 400 Vancouver WA 98664-3290 |
| Mailing Address |
Po Box 1588 Vancouver WA 98668-1588 |
| Practice Telephone | 3602562640 |
| Enumeration Date | 2011-07-26 |
| Last Update Date | 2011-07-26 |
| Authorized Official Name | MR. STEVEN L HOLT (DELEGATED OFFICIAL) |
| Authorized Official Telephone | 3605147044 |
| Is Organization Subpart | Y |
| Parent Organization Name | PEACEHEALTH SOUTHWEST MEDICAL CENTER |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| PeaceHealth SW Heart & Vascular Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548734205 | Peacehealth Southwest Medical Center | Rehabilitation Unit | 400 Ne Mother Joseph Pl, Vancouver, WA 98664-3200 | 2019-01-16 |
| 1285720896 | Peacehealth Southwest Medical Center | Home Health | 100 E 33rd St, Vancouver, WA 98663 | 2006-10-04 |
| 1134178999 | Peacehealth Southwest Medical Center | Psychiatric Unit | 400 Ne Mother Joseph Pl, Vancouver, WA 98664-3200 | 2006-05-09 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PEACEHEALTH SOUTHWEST MEDICAL CENTER | 400 Ne Mother Joseph Pl, Vancouver, WA 98664-3200 |
| Washington State Corporations | PEACEHEALTH SOUTHWEST MEDICAL CENTER | 1115 Se 164th Avenue, Vancouver, WA 98683 |
| Washington State Corporations | PEACEHEALTH SOUTHWEST MEDICAL CENTER FOUNDATION | 1115 Se 164th Ave Dept 302, Vancouver, WA 98683-8002 |
| Street Address |
200 NE MOTHER JOSEPH PL STE 400 |
| City | VANCOUVER |
| State | WA |
| Zip Code | 98664-3290 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598051252 | Joshua Grant | Internal Medicine | 200 Ne Mother Joseph Pl Ste 400, Vancouver, WA 98664-3290 | 2011-06-21 |
| 1962940015 | Hajir Zohourian | Internal Medicine | 200 Ne Mother Joseph Pl Ste 400, Vancouver, WA 98664-3290 | 2017-02-09 |
| 1568892586 | Shenjing Li | Internal Medicine | 200 Ne Mother Joseph Pl Ste 400, Vancouver, WA 98664-3290 | 2013-11-13 |
| 1376819367 | Olga Victorovna Demina | Internal Medicine | 200 Ne Mother Joseph Pl Ste 400, Vancouver, WA 98664 | 2012-03-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285249938 | Angelica Maria Parle-fresquez | Speech-Language Pathologist | Early Childhood Assessment Center - Lieser School, 301 S. Lieser Rd, Vancouver, WA 98664 | 2020-09-10 |
| 1467923441 | Elizabeth Steen | Counselor | 230 E. State St., Mossyrock, WA 98664 | 2018-12-17 |
| 1497241657 | Chelsey Nicole Parker | Peer Specialist | 9815 Ne 3rd St, Vancouver, WA 98664 | 2018-07-10 |
| 1881145431 | Brent Homan | Occupational Therapist | 807 Se Morgan Rd., Vancouver, WA 98664 | 2016-10-19 |
| 1114474277 | Rebecca Marie Stefan | Nurse's Aide | 10025 Ne 19th St, Vancouver, WA 98664 | 2016-09-07 |
| 1528454105 | Alicia Ford | Dietitian, Registered | 700 Ne 87th Ave Ste 280, Vancouver, WA 98664 | 2015-04-10 |
| 1033504261 | Reid Roberts Bennett | Anesthesiology | 505 Ne 87th Ave Ste 210, Vancouver, WA 98664 | 2015-04-03 |
| 1235550856 | Nikolay Nikolaevich Chernukhin Jr. | Chiropractor | 221-a Ne 104th Ave, Suite 205, Vancouver, WA 98664 | 2013-12-27 |
| 1013278712 | Serena Harker | Physical Therapy Assistant | 221a Ne 104th Ave, Suite #205, Vancouver, WA 98664 | 2012-05-30 |
| 1295091080 | Rebeca C Johnson | Massage Therapist | 11015 Ne 4th Plain Suite B, Vancouver, WA 98664 | 2012-04-05 |
| Find all providers in zip 98664 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023357845 | Samuel Everett George | Internal Medicine | 19005 Se 34th St Bldg 3, Vancouver, WA 98683 | 2013-02-14 |
| 1063716595 | Jeffrey David Feldstein | Internal Medicine | 5415 Ne 52nd St, Vancouver, WA 98661-7838 | 2010-12-23 |
| 1376790758 | Vishesh Kumar | Internal Medicine | 700 Ne 87th Ave Ste 210, Vancouver, WA 98664-4896 | 2008-08-27 |
| 1003918616 | John Megcheisen Stone | Internal Medicine | 1805 Se Solomon Loop, Vancouver, WA 98683-4631 | 2006-09-03 |
| 1801894878 | Stephen L Cook | Internal Medicine | 1115 Se 164th Ave, Dept 358, Vancouver, WA 98683-9324 | 2005-07-13 |
| 1962940015 | Hajir Zohourian | Internal Medicine | 200 Ne Mother Joseph Pl Ste 400, Vancouver, WA 98664-3290 | 2017-02-09 |
| 1245594464 | Noel Samantha Lee | Internal Medicine | 700 Ne 87th Ave Ste 210, Vancouver, WA 98664 | 2012-07-03 |
| 1376819367 | Olga Victorovna Demina | Internal Medicine | 200 Ne Mother Joseph Pl Ste 400, Vancouver, WA 98664 | 2012-03-24 |
| 1538458807 | Providence Health & Services - Oregon | Internal Medicine | 315 Se Stone Mill Dr, Suite 220, Vancouver, WA 98684-6987 | 2011-04-07 |
| 1902042187 | Celia Katherine Dervan | Internal Medicine | 700 Ne 87th Ave, Vancouver, WA 98664-1913 | 2008-12-18 |
| Find all providers in VANCOUVER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.