Provider Demographics
NPI:1154302925
Name:PEACEHEALTH
Entity Type:Organization
Organization Name:PEACEHEALTH
Other - Org Name:SACRED HEART HOME INFUSION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SYS VP FIN INTEGRIT/CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SEIRER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-729-1132
Mailing Address - Street 1:1115 SE 164TH AVE DEPT 328
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-8003
Mailing Address - Country:US
Mailing Address - Phone:360-729-1462
Mailing Address - Fax:360-729-3104
Practice Address - Street 1:677 E 12TH AVE
Practice Address - Street 2:SUITE N-170
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3600
Practice Address - Country:US
Practice Address - Phone:458-205-7200
Practice Address - Fax:458-205-7215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR122767Medicaid
OR122767Medicaid