1992033153 NPI number — CENTRAL PENINSULA GENERAL HOSPITAL INC

Table of content: (NPI 1992033153)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992033153 NPI number — CENTRAL PENINSULA GENERAL HOSPITAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL PENINSULA GENERAL HOSPITAL INC
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:
CENTRAL PENINSULA NEUROLOGY CLINIC
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:
1992033153
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 HOSPITAL PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOLDOTNA
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99669-7559
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-714-4090
Provider Business Mailing Address Fax Number:
907-714-4697

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
262 N BINKLEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOLDOTNA
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-714-4090
Provider Business Practice Location Address Fax Number:
907-714-4697
Provider Enumeration Date:
11/30/2009

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
907-714-4723

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  937106 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 282NR1301X , with the licence number: 937106 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0004 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 155 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1583121 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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