Healthcare Provider Details

I. General information

NPI: 1003299108
Provider Name (Legal Business Name): CENTRAL PENINSULA GENERAL HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 FRONTAGE RD SUITE 123
KENAI AK
99611-9104
US

IV. Provider business mailing address

250 HOSPITAL PL
SOLDOTNA AK
99669-7559
US

V. Phone/Fax

Practice location:
  • Phone: 907-283-4611
  • Fax: 907-283-3992
Mailing address:
  • Phone: 907-714-4404
  • Fax: 907-714-4696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License NumberGACH-003
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateAK

VIII. Authorized Official

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