Healthcare Provider Details

I. General information

NPI: 1487815254
Provider Name (Legal Business Name): CENTRAL PENINSULA GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 HOSPITAL PL
SOLDOTNA AK
99669-7559
US

IV. Provider business mailing address

250 HOSPITAL PL
SOLDOTNA AK
99669-7559
US

V. Phone/Fax

Practice location:
  • Phone: 907-714-4515
  • Fax: 907-714-4696
Mailing address:
  • Phone: 907-714-4515
  • Fax: 907-714-4696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number196
License Number StateAK

VIII. Authorized Official

Name: MRS. MARCIA ELICE ANDERSON
Title or Position: CLINICAL DIETITIAN
Credential: RD
Phone: 907-714-4752