Provider Demographics
NPI:1134658479
Name:PEACEHEALTH MEDICAL GROUP
Entity Type:Organization
Organization Name:PEACEHEALTH MEDICAL GROUP
Other - Org Name:PHMG URGENT CARE VALLEY RIVER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE PHMG
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:METCALF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-729-1743
Mailing Address - Street 1:1115 SE 164TH AVE DEPT 358
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-8004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 VALLEY RIVER DR STE 110
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6758
Practice Address - Country:US
Practice Address - Phone:541-222-7378
Practice Address - Fax:541-222-7389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-09
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies