Healthcare Provider Details

I. General information

NPI: 1972666345
Provider Name (Legal Business Name): PETERSBURG MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 FRAM STREET
PETERSBURG AK
99833-0589
US

IV. Provider business mailing address

PO BOX 589
PETERSBURG AK
99833-0589
US

V. Phone/Fax

Practice location:
  • Phone: 907-772-4299
  • Fax: 907-772-9273
Mailing address:
  • Phone: 907-772-4291
  • Fax: 907-772-3085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateAK

VIII. Authorized Official

Name: MR. JOHN BRINGHURST
Title or Position: CEO
Credential:
Phone: 907-772-4291