1134178999 NPI number — PEACEHEALTH SOUTHWEST MEDICAL CENTER

Table of content: (NPI 1134178999)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134178999 NPI number — PEACEHEALTH SOUTHWEST MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEACEHEALTH SOUTHWEST MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134178999
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1115 SE 164TH AVE DEPT 328
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98683-8003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-729-1462
Provider Business Mailing Address Fax Number:
360-729-3104

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 NE MOTHER JOSEPH PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98664-3200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-256-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SEIRER
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
Authorized Official Title or Position:
SYS VP FIN INTEGRITY/CONTROLLER
Authorized Official Telephone Number:
360-729-1132

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 273R00000X , with the licence number: H-170 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 273Y00000X , with the licence number: H-170 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: H-170 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 315D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7034754 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7300445 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3200292 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7056765 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7062193 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7099260 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7013436 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7070154 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7064579 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7071954 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3304409 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7013428 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7407844 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7014350 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9634890 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com