Healthcare Provider Details

I. General information

NPI: 1538631478
Provider Name (Legal Business Name): CENTRAL PENINSULA GENERAL HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 N BINKLEY ST STE 202
SOLDOTNA AK
99669-7500
US

IV. Provider business mailing address

250 HOSPITAL PL
SOLDOTNA AK
99669-7559
US

V. Phone/Fax

Practice location:
  • Phone: 907-714-4521
  • Fax: 907-260-4063
Mailing address:
  • Phone: 907-714-4521
  • Fax: 907-260-4063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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