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General NPI Number Information
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NPI Number | 1639523418
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Entity Type | Organization
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Legal Business Name | CENTRAL PENINSULA GENERAL HOSPITAL, INC
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Dates
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Enumeration Date | 04/19/2016
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Last Update Date | 12/07/2020
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Provider Practice Location Address
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Address Line | 247 N FIREWEED ST STE A
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City | SOLDOTNA
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State | AK
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Zip | 99669-7593
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Country | US
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Telephone | 907-262-8597
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Fax | 907-262-6516
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Provider Business Mailing Address
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Address Line | 250 HOSPITAL PL
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City | SOLDOTNA
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State | AK
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Zip | 99669-7559
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Country | US
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Telephone | 907-714-5640
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Fax | 907-714-5205
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Authorized Official
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Title or Position | CEO
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Name | RICHARD DAVIS
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Credential |
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Telephone | 907-714-4723
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 1034006
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License Number State | AK
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