Basic Information
| Provider Information | |||||||||
| NPI: | 1558015057 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PEACEHEALTH SOUTHWEST MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1115 SE 164TH AVE DEPT 328 | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986838003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607291462 | ||||||||
| FaxNumber: | 3607293104 | ||||||||
| Practice Location | |||||||||
| Address1: | 5400 MACARTHUR BLVD | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986617049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606965100 | ||||||||
| FaxNumber: | 3606965038 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2022 | ||||||||
| LastUpdateDate: | 02/04/2022 | ||||||||
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| AuthorizedOfficialLastName: | SEIRER | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | SYS VP FIN INTEGRIT/CONTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 3607291132 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PEACEHEALTH | ||||||||
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| NPICertificationDate: | 02/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | N | Agencies | Hospice Care, Community Based | 315D00000X | Y | Nursing & Custodial Care Facilities | Hospice, Inpatient |
No ID Information.