Healthcare Provider Details

I. General information

NPI: 1396705539
Provider Name (Legal Business Name): PEACEHEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
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 TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberNO NUMBER ASSIGNED
License Number StateAK

VIII. Authorized Official

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