Healthcare Provider Details

I. General information

NPI: 1801965736
Provider Name (Legal Business Name): PEACEHEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 08/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 TONGASS AVE
KETCHIKAN AK
99901-5746
US

IV. Provider business mailing address

PO BOX 1798
BELLINGHAM WA
98227-1798
US

V. Phone/Fax

Practice location:
  • Phone: 907-228-8300
  • Fax: 907-228-8518
Mailing address:
  • Phone: 360-734-5400
  • Fax: 360-715-6552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateAK
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateAK
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateAK
# 6
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateAK
# 7
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberNO NUMBERS ISSUED
License Number StateAK
# 8
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberNO NUMBERS ISSUED
License Number StateAK
# 9
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberNO NUMBERS ISSUED
License Number StateAK
# 10
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberNO NUMBERS ISSUED
License Number StateAK
# 11
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberNO NUMBERS ISSUED
License Number StateAK
# 12
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateAK
# 13
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number StateAK
# 14
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberNO NUMBERS ISSUED
License Number StateAK

VIII. Authorized Official

Name: PATRICK J BRANCO
Title or Position: CEO
Credential:
Phone: 907-228-8300