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General NPI Number Information
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NPI Number | 1659825776
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Entity Type | Organization
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Legal Business Name | PENINSULA COMMUNITY HEALTH SERVICES OF ALASKA, INC.
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Dates
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Enumeration Date | 08/05/2016
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Last Update Date | 04/25/2023
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Provider Practice Location Address
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Address Line | 805 FRONTAGE RD SUITE 130
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City | KENAI
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State | AK
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Zip | 99611-9104
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Country | US
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Telephone | 907-283-3600
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Fax | 907-283-3601
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Provider Business Mailing Address
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Address Line | PO BOX 2949
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City | SOLDOTNA
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State | AK
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Zip | 99669-2949
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Country | US
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Telephone | 907-260-7300
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Fax | 907-260-7301
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Authorized Official
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Title or Position | CEO
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Name | BENJAMIN J WRIGHT
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Credential |
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Telephone | 907-260-7314
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | 920499
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License Number State | AK
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