Healthcare Provider Details

I. General information

NPI: 1770131930
Provider Name (Legal Business Name): CAPITOLMED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2019
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 JEFFERSON WAY SUITE 102B
KETCHIKAN AK
99901-5953
US

IV. Provider business mailing address

25 JEFFERSON WAY STE 102B
KETCHIKAN AK
99901-5953
US

V. Phone/Fax

Practice location:
  • Phone: 907-247-7827
  • Fax: 973-215-2052
Mailing address:
  • Phone: 907-247-7827
  • Fax: 973-215-2052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. KEVIN A HALL
Title or Position: OWNER / PHYSICIAN
Credential: M.D.
Phone: 907-247-7827