Healthcare Provider Details

I. General information

NPI: 1588207179
Provider Name (Legal Business Name): CENTRAL PENINSULA GENERAL HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2019
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10128 KENAI SPUR HWY
KENAI AK
99611-7807
US

IV. Provider business mailing address

250 HOSPITAL PL
SOLDOTNA AK
99669-7559
US

V. Phone/Fax

Practice location:
  • Phone: 907-714-5740
  • Fax:
Mailing address:
  • Phone: 907-714-4502
  • Fax: 907-262-2745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RICHARD LANE DAVIS
Title or Position: CEO
Credential:
Phone: 907-714-4723