Healthcare Provider Details

I. General information

NPI: 1225263445
Provider Name (Legal Business Name): CENTRAL PENINSULA GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 08/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 N. FIREWEED STREET SUITE C
SOLDOTNA AK
99669-7540
US

IV. Provider business mailing address

289 N. FIREWEED STREET SUITE C
SOLDOTNA AK
99669-7540
US

V. Phone/Fax

Practice location:
  • Phone: 907-714-4045
  • Fax:
Mailing address:
  • Phone: 907-714-4045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number928993
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number928993
License Number StateAK

VIII. Authorized Official

Name: MR. RYAN K SMITH
Title or Position: CEO
Credential:
Phone: 907-714-4718