Healthcare Provider Details

I. General information

NPI: 1225266588
Provider Name (Legal Business Name): CORDOVA COMMUNITY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 CHASE AVE
CORDOVA AK
99574-0160
US

IV. Provider business mailing address

602 CHASE AVE
CORDOVA AK
99574-0160
US

V. Phone/Fax

Practice location:
  • Phone: 907-424-8000
  • Fax: 907-424-8116
Mailing address:
  • Phone: 907-424-8000
  • Fax: 907-424-8116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierHS07LT
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer
# 2
IdentifierHS07OP
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer
# 3
IdentifierHS07SB
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer
# 4
IdentifierHS07IP
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer

VIII. Authorized Official

Name: DR. HANNAH JOANN SANDERS
Title or Position: CEO
Credential: MD
Phone: 907-424-8200