Provider Demographics
NPI:1447217559
Name:PEACEHEALTH
Entity Type:Organization
Organization Name:PEACEHEALTH
Other - Org Name:ST JOSEPH MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZENDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-738-6797
Mailing Address - Street 1:2901 SQUALICUM PKWY
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1851
Mailing Address - Country:US
Mailing Address - Phone:360-734-5400
Mailing Address - Fax:360-756-6890
Practice Address - Street 1:2800 DOUGLAS AVENUE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225
Practice Address - Country:US
Practice Address - Phone:360-788-5877
Practice Address - Fax:360-788-6890
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST JOSEPH MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-01
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251G00000X
WAIHS.FS.00000471315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3990744Medicaid
501537Medicare ID - Type Unspecified