Healthcare Provider Details

I. General information

NPI: 1225761083
Provider Name (Legal Business Name): CENTRAL PENINSULA GENERAL HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 TRADING BAY RD STE 9
KENAI AK
99611-7786
US

IV. Provider business mailing address

250 HOSPITAL PL
SOLDOTNA AK
99669-6999
US

V. Phone/Fax

Practice location:
  • Phone: 907-714-4404
  • Fax:
Mailing address:
  • Phone: 907-714-4502
  • Fax: 907-714-4696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHAUN KEEF
Title or Position: CEO
Credential:
Phone: 907-714-4719