Provider Demographics
NPI:1215035787
Name:CORDOVA COMMUNITY MEDICAL CENTER
Entity Type:Organization
Organization Name:CORDOVA COMMUNITY MEDICAL CENTER
Other - Org Name:CORDOVA COMMUNITY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:DENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:STAVIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-424-8228
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:602 CHASE AVE
Mailing Address - City:CORDOVA
Mailing Address - State:AK
Mailing Address - Zip Code:99574-0160
Mailing Address - Country:US
Mailing Address - Phone:907-424-8000
Mailing Address - Fax:907-424-8116
Practice Address - Street 1:602 CHASE AVE
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:AK
Practice Address - Zip Code:99574-0160
Practice Address - Country:US
Practice Address - Phone:907-424-8000
Practice Address - Fax:907-424-8116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK282NC0060X, 313M00000X, 314000000X
3416L0300X, 385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No3416L0300XTransportation ServicesAmbulanceLand Transport
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCM6143Medicaid
AKCM9745Medicaid
AKCMG287Medicaid
AKHS07IPMedicaid
AK0200927OtherNCPDP PHARM #
AKDA4455Medicaid
AKHC2871Medicaid
AKHS07OPMedicaid
AKMH6324Medicaid
AKHS07LTMedicaid
AKHS07SBMedicaid
AK025028Medicare Oscar/Certification
AK0200927OtherNCPDP PHARM #
AKMH6324Medicaid