=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487917233
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEACEHEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2012
-----------------------------------------------------
Last Update Date | 03/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1117 SPRING STREET
-----------------------------------------------------
City | FRIDAY HARBOR
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98250-7303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-378-2141
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1115 SE 164TH AVE DEPT 328
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98683-8003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-729-1462
-----------------------------------------------------
Fax | 360-729-3104
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SYS VP FIN INTEGRITY/CONTROLLER
-----------------------------------------------------
Name | JEFFREY SEIRER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 360-729-1132
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282NC0060X
-----------------------------------------------------
Taxonomy Name | Critical Access Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------