PEACEHEALTH (NPI# 1255977591) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255977591 |
| Entity Type | Organization |
| Organization Name | PEACEHEALTH |
| Other Organization Name | PEACEHEALTH LONGVIEW UROLOGY |
| Practice Address |
625 9th Ave Ste 120 Longview WA 98632-2465 |
| Mailing Address |
1115 Se 164th Ave Dept 358 Vancouver WA 98683-8004 |
| Practice Telephone | 3606368950 |
| Practice Fax Number | 3606368951 |
| Mailing Telephone | 3607291462 |
| Mailing Fax Number | 3607293104 |
| Enumeration Date | 2019-11-21 |
| Last Update Date | 2019-11-27 |
| Authorized Official Name | MICHAEL CHARLES METCALF (CHIEF EXECUTIVE PHMG) |
| Authorized Official Telephone | 3607291743 |
| Is Organization Subpart | Y |
| Parent Organization Name | PEACEHEALTH |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| Y | 208800000X | Urology | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| PeaceHealth Longview Urology | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184106437 | Peacehealth | Durable Medical Equipment & Medical Supplies | Triangle Mall Suite 16 1015 Ocean Beach Hwy, Longview, WA 98632 | 2018-09-04 |
| 1669766457 | Peacehealth | General Acute Care Hospital | 787 Woodland Acres Ln, Eugene, OR 97402-9378 | 2011-06-09 |
| 1760427082 | Peacehealth | Home Health | 126 Washington St, Ketchikan, AK 99901-5930 | 2006-06-19 |
| 1912957986 | Peacehealth | Clinical Medical Laboratory | 123 International Way, Springfield, OR 97477-1047 | 2006-05-11 |
| 1083672273 | Peacehealth | Rehabilitation Unit | 809 E Chestnut St, Bellingham, WA 98225-5221 | 2006-05-04 |
| 1447217559 | Peacehealth | Hospice, Inpatient | 2800 Douglas Avenue, Bellingham, WA 98225 | 2006-05-01 |
| 1215918719 | Peacehealth | Hospice Care, Community Based | 2230 Kingwood Street, Florence, OR 97439-9470 | 2005-11-10 |
| 1225019011 | Peacehealth | Home Health | 2230 Kingwood St, Florence, OR 97439-9464 | 2005-11-08 |
| 1346237971 | Peacehealth | General Acute Care Hospital | 1255 Hilyard St, Eugene, OR 97401-3718 | 2005-09-29 |
| 1689677320 | Peacehealth | General Acute Care Hospital | 2901 Squalicum Pkwy, Bellingham, WA 98225-1851 | 2005-05-25 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PEACEHEALTH | 1115 Se 164th Avenue, Vancouver, WA 98683-9324 |
| Washington State Corporations | PEACEHEALTH | 1115 Se 164th Ave Dept. 302, Vancouver, WA 98683 |
| Oregon Corporations, Companies and Business Names | PEACEHEALTH | 1115 Se 164th Ave Dept 302, Vancouver, WA 98683 |
| Oregon Corporations, Companies and Business Names | PEACEHEALTH - COTTAGE GROVE | 1515 Village Dr, Cottage Grove, OR 97424 |
| Washington State Corporations | PEACEHEALTH ASC BELLINGHAM, LLC | 1115 Se 164th Ave, Dept 302, Vancouver, WA 98683-9324 |
| Oregon Corporations, Companies and Business Names | PEACEHEALTH COTTAGE GROVE COMMUNITY MEDICAL CENTER | 1515 Village Dr, Cottage Grove, OR 97424 |
| Oregon Corporations, Companies and Business Names | PEACEHEALTH COTTAGE GROVE COMMUNITY MEDICAL CENTER FOUNDATION | 1515 Village Dr, Cottage Grove, OR 97424 |
| Oregon Corporations, Companies and Business Names | PEACEHEALTH COTTAGE GROVE COMMUNITY MEDICAL CENTER SWING | 1515 Village Drive, Cottage Grove, OR 97424 |
| Oregon Corporations, Companies and Business Names | PEACEHEALTH HOSPITAL MEDICINE | 3333 Riverbend Dr, Springfield, OR 97477 |
| Oregon Corporations, Companies and Business Names | PEACEHEALTH LABORATORIES | 123 International Way, Springfield, OR 97477 |
| Street Address |
625 9TH AVE STE 120 |
| City | LONGVIEW |
| State | WA |
| Zip Code | 98632-2465 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851992366 | Honor Senior Care LLC | Home Health Aide | 1135 3rd Ave, Ste S101, Longview, WA 98632 | 2020-11-03 |
| 1417416728 | Sam Wise | Dentist | 1538 11th Ave Lowr Columbia, Longview, WA 98632 | 2019-03-16 |
| 1053870717 | Matthew Johnson | Physician Assistant | 900 Ocean Beach Hwy Ste 110, Longview, WA 98632 | 2019-03-12 |
| 1295205367 | Abid Valji | Occupational Therapist | Americana Health and Rehabilitation Center, 917 7th Ave, Longview, WA 98632 | 2018-11-30 |
| 1184106437 | Peacehealth | Durable Medical Equipment & Medical Supplies | Triangle Mall Suite 16 1015 Ocean Beach Hwy, Longview, WA 98632 | 2018-09-04 |
| 1982186318 | Linda Joan Mason | Licensed Practical Nurse | 1153 23rd Ave, Longview, WA 98632 | 2018-09-01 |
| 1891291910 | Ellen Sumner Hornbeak | Physical Therapist | 200 Triangle Shopping Ctr Ste 270, Longview, WA 98632 | 2018-04-05 |
| 1700399961 | Johnna Joyce Knapp | Speech-Language Pathologist | 2615 Lilac St, Longview, WA 98632 | 2017-11-09 |
| 1841711868 | Deborah Annette Burzynski | Registered Nurse | 1057 12th Avenue, Longview, WA 98632 | 2017-06-29 |
| 1598291122 | Cheyenne West | Counselor | 1616 10th Avenue, Longview, WA 98632 | 2017-05-02 |
| Find all providers in zip 98632 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649780453 | Paul Bradley Md Pllc | Urology | 703 E Marshall Ave Ste 4009, Longview, TX 75601-5500 | 2017-10-06 |
| 1457642282 | Landon Taylor Erickstad | Urology | 802 Medical Dr Ste 400, Longview, TX 75605-5205 | 2011-04-27 |
| 1639207574 | Gid Roger Johnson | Urology | 1608 Sweetbriar St, Longview, TX 75604-2654 | 2007-03-01 |
| 1780658112 | Robert W Frederick | Urology | 703 E Marshall Ave Ste 5007, Longview, TX 75601 | 2006-02-14 |
| 1285632919 | Patrick M Lassen | Urology | 625 9th Ave, Suite 120, Longview, WA 98632-2464 | 2005-07-07 |
| 1932369832 | Paul R Bradley | Urology | 703 E Marshall Ave, Suite 5007, Longview, TX 75601-5500 | 2008-06-13 |
| 1346430527 | Adrienne J K Carmack | Urology | 703 E Marshall Ave, Suite 5007, Longview, TX 75601-5500 | 2007-07-25 |
| 1790847994 | M'liss A Hudson | Urology | 802 Medical Dr, Suite 400, Longview, TX 75605-5100 | 2006-12-14 |
| 1588688402 | John Thomas Mansfield | Urology | 625 9th Ave, Suite 120, Longview, WA 98632-2464 | 2006-07-26 |
| 1700853793 | Gregory A Edwards | Urology | 802 Medical Dr, Suite 400, Longview, TX 75605-5100 | 2006-03-08 |
| Find all providers in LONGVIEW | ||||
Please comment or provide details below to improve the information on PEACEHEALTH.
| 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.