Provider Demographics
NPI:1003299108
Name:CENTRAL PENINSULA GENERAL HOSPITAL, INC
Entity Type:Organization
Organization Name:CENTRAL PENINSULA GENERAL HOSPITAL, INC
Other - Org Name:KENAI MEDICAL CENTER - CPH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-714-4723
Mailing Address - Street 1:250 HOSPITAL PL
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7559
Mailing Address - Country:US
Mailing Address - Phone:907-714-4404
Mailing Address - Fax:907-714-4696
Practice Address - Street 1:805 FRONTAGE RD
Practice Address - Street 2:SUITE 123
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-9104
Practice Address - Country:US
Practice Address - Phone:907-283-4611
Practice Address - Fax:907-283-3992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK207Q00000X
AKGACH-003282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No282NR1301XHospitalsGeneral Acute Care HospitalRuralGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK020024Medicare Oscar/Certification
AKK0000ZBBBZMedicare Oscar/Certification