Healthcare Provider Details

I. General information

NPI: 1639494263
Provider Name (Legal Business Name): CENTRAL PENINSULA GENERAL HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2010
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 HOSPITAL PL STE 204
SOLDOTNA AK
99669-7559
US

IV. Provider business mailing address

250 HOSPITAL PL
SOLDOTNA AK
99669-7559
US

V. Phone/Fax

Practice location:
  • Phone: 907-714-4120
  • Fax: 907-714-4696
Mailing address:
  • Phone: 907-714-4120
  • Fax: 907-714-4696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number941255
License Number StateAK

VIII. Authorized Official

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