Healthcare Provider Details

I. General information

NPI: 1679566269
Provider Name (Legal Business Name): SOUTH PENINSULA HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 BARTLETT STREET
HOMER AK
99603-7005
US

IV. Provider business mailing address

4300 BARTLETT ST
HOMER AK
99603-7005
US

V. Phone/Fax

Practice location:
  • Phone: 907-235-8101
  • Fax: 907-235-0253
Mailing address:
  • Phone: 907-235-8101
  • Fax: 907-235-0253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC0050X
TaxonomyCritical Access Hospital Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. RYAN SMITH
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 907-235-0241