1215035787 NPI number — CORDOVA COMMUNITY MEDICAL CENTER

Table of content: (NPI 1215035787)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215035787 NPI number — CORDOVA COMMUNITY MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORDOVA COMMUNITY MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CORDOVA COMMUNITY MEDICAL CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215035787
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 160
Provider Second Line Business Mailing Address:
602 CHASE AVE
Provider Business Mailing Address City Name:
CORDOVA
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99574-0160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-424-8000
Provider Business Mailing Address Fax Number:
907-424-8116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
602 CHASE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORDOVA
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99574-0160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-424-8000
Provider Business Practice Location Address Fax Number:
907-424-8116
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STAVIG
Authorized Official First Name:
DENNA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF FINANCE
Authorized Official Telephone Number:
907-424-8228

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 313M00000X , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385HR2060X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CM6143 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: CM9745 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: CMG287 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: HS07IP , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0200927 . This is a "NCPDP PHARM #" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
  • Identifier: DA4455 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: HC2871 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: HS07OP , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: MH6324 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: HS07LT , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: HS07SB , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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