Healthcare Provider Details

I. General information

NPI: 1215035787
Provider Name (Legal Business Name): CORDOVA COMMUNITY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 CHASE AVE
CORDOVA AK
99574-0160
US

IV. Provider business mailing address

PO BOX 160 602 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 Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateAK
# 4
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: DENNA STAVIG
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 907-424-8228