Healthcare Provider Details

I. General information

NPI: 1902232507
Provider Name (Legal Business Name): PEACEHEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2013
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 SPRING ST
FRIDAY HARBOR WA
98250-9782
US

IV. Provider business mailing address

1115 SE 164TH AVE DEPT 358
VANCOUVER WA
98683-8004
US

V. Phone/Fax

Practice location:
  • Phone: 360-378-2141
  • Fax:
Mailing address:
  • Phone: 360-729-2161
  • Fax: 541-431-8213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberHAC.FS.60316803
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberHAC.FS.60316803
License Number StateWA

VIII. Authorized Official

Name: MR. RONALD LYNN SAXTON
Title or Position: EVP & GENERAL COUNSEL
Credential:
Phone: 360-729-1108