Organization · Type 2 NPI

Peacehealth

Prosthetic/Orthotic Supplier · Longview, WA

NPI number 1184106437 Active

Practice location

Triangle Mall Suite 16 1015 Ocean Beach Hwy
Longview, WA 98632

Call (360) 501-3750 Map

Fax (360) 501-3751

Mailing address

1115 SE 164th Ave Dept 358
Vancouver, WA 98683-8004

Specialties and licenses

Taxonomy	Code	License
Durable Medical Equipment & Medical Supplies	332B00000X	None listed
Prosthetic/Orthotic Supplier Primary	335E00000X	None listed

Prosthetic/Orthotic Supplier: An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition.

Other prosthetic/orthotic supplier providers in Longview

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NPI record

NPI: 1184106437
Entity type: Organization (Type 2)
Issued: Sep 4, 2018
Last updated: Sep 4, 2018
Status: Active

Other names

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St. John Medical Center-Peacehealth Therapy and Wellness · doing business as
St. John Medical Center-Peacehealth Therapy and Wellness · doing business as

Authorized official

Michael Charles Metcalf
Chief Executive PHMG
(360) 729-1743

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1184106437

Peacehealth's National Provider Identifier is 1184106437, issued on Sep 4, 2018. The primary taxonomy on file is Prosthetic/Orthotic Supplier (335E00000X), and the practice location is in Longview, WA. The record was last updated on Sep 4, 2018.