COWLITZ FAMILY HEALTH CENTER (NPI# 1053472993) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053472993 |
| Entity Type | Organization |
| Organization Name | COWLITZ FAMILY HEALTH CENTER |
| Practice Address |
1251 Lewis River Rd Ste D Woodland WA 98674-9203 |
| Mailing Address |
1057 12th Ave Longview WA 98632-2509 |
| Practice Telephone | 3602254310 |
| Practice Fax Number | 3602254339 |
| Mailing Telephone | 3606363892 |
| Mailing Fax Number | 3604141114 |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2020-05-20 |
| Authorized Official Name | DIAN COOPER (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 3606363892 |
| Is Organization Subpart | Y |
| Parent Organization Name | COWLITZ FAMILY HEALTH CENTER |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QD0000X |
Clinic/Center Specialization: Dental |
WA | Ambulatory Health Care Facilities | |
| N | 261QF0050X |
Clinic/Center Specialization: Family Planning, Non-Surgical |
========= | WA | Ambulatory Health Care Facilities |
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
========= | WA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 7900426 | 05 | |
| WA | 7086523 | 05 | |
| WA | 7407349 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962876748 | Cowlitz Family Health Center | Clinic/Center | 784 14th Ave, Longview, WA 98632-2315 | 2015-11-17 |
| 1801266481 | Cowlitz Family Health Center | Clinic/Center | 139 1st Ave Sw, Castle Rock, WA 98611 | 2015-09-25 |
| 1376910885 | Cowlitz Family Health Center | Community/Behavioral Health | 1057 12th Ave, Longview, WA 98632-2509 | 2015-09-01 |
| 1104243534 | Cowlitz Family Health Center | Clinic/Center | 621 Grade St, Kelso, WA 98626-2606 | 2014-03-24 |
| 1366790008 | Cowlitz Family Health Center | Clinic/Center | 300 Oak St Ste B, Kelso, WA 98626-2304 | 2012-08-28 |
| 1538497417 | Cowlitz Family Health Center | Clinic/Center | 335 Una Ave, Cathlamet, WA 98612-9583 | 2009-12-03 |
| 1184824203 | Cowlitz Family Health Center | Clinic/Center | 1057 12th Ave, Longview, WA 98632-2509 | 2007-07-18 |
| 1437359551 | Cowlitz Family Health Center | Case Management | 1057 12th Ave, Longview, WA 98632-2509 | 2007-07-18 |
| 1700086824 | Cowlitz Family Health Center | Clinic/Center | 1057 12th Ave, Longview, WA 98632-2509 | 2007-07-18 |
| 1073711081 | Cowlitz Family Health Center | Clinic/Center | 1057 12th Ave, Longview, WA 98632-2509 | 2007-07-11 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | COWLITZ FAMILY HEALTH CENTER | 1057 12th Ave, Longview, WA 98632-2509 |
| Street Address |
1251 LEWIS RIVER RD STE D |
| City | WOODLAND |
| State | WA |
| Zip Code | 98674-9203 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710528914 | Crystal Che Williams | Nurse Practitioner | 1251 Lewis River Rd Ste D, Woodland, WA 98674-9203 | 2019-09-30 |
| 1679068753 | Brenna Marie Chandler | Nurse Practitioner | 1251 Lewis River Rd Ste D, Woodland, WA 98674-9203 | 2018-06-29 |
| 1558855353 | Craig W Jones | Registered Nurse | 1251 Lewis River Rd Ste D, Woodland, WA 98674-9203 | 2018-06-15 |
| 1043602147 | Mary Benson | Nurse Practitioner | 1251 Lewis River Rd Ste D, Woodland, WA 98674-9203 | 2015-02-26 |
| 1265662233 | Sean Noel Murray | Nurse Practitioner | 1251 Lewis River Rd Ste D, Woodland, WA 98674-9203 | 2009-07-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790328409 | Susan E Van Skike | Social Worker | 38503 Nw Goose Hill Avenue, Woodland, WA 98674 | 2019-10-25 |
| 1336599323 | Erin Hutchinson | Counselor | 1251 Lewis River Road, Ste. A, Woodland, WA 98674 | 2016-06-21 |
| 1972977577 | Kelsey Ann Miller | Speech-Language Pathologist | 800 Second Street Wsd Special Service, Woodland, WA 98674 | 2015-11-19 |
| 1598194482 | Elizabeth Grendahl | Massage Therapist | 1227-h North Goerig, Woodland, WA 98674 | 2013-11-01 |
| 1417258674 | Safeway Pharmacy | Pharmacy | Safeway 1725 Pacific Avenue, Woodland, WA 98674 | 2010-11-04 |
| 1538370267 | Tiffany Marie Rose | Massage Therapist | 38803 Ne 2nd Ave, Lacenter, WA 98674 | 2007-05-24 |
| 1417161555 | Jack L Vandyke | Dentist | 640 Georig St, Woodland, WA 98674 | 2007-05-09 |
| 1619934007 | Pearson Medical Clinic Pllc | Internal Medicine | 527 2nd Street, Woodland, WA 98674 | 2006-04-28 |
| 1083914733 | Wal-mart Stores Inc | Technician/Technologist | 1486 Dike Access Rd, Woodland, VA 98674 | 2010-10-28 |
| 1710018213 | Tammy Wallace | Specialist | 1227 Goerig Rd, Ste H, Woodland, WA 98674 | 2007-03-08 |
| Find all providers in zip 98674 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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| Find all providers with the same taxonomy | ||||
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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.