Provider Demographics
NPI:1225266588
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:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:JOANN
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-424-8200
Mailing Address - Street 1:602 CHASE AVE
Mailing Address - Street 2:
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:2009-06-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHS07LTMedicaid
AKHS07OPMedicaid
AKHS07SBMedicaid
AKHS07IPMedicaid
AKHS07SBMedicaid
AKHS07IPMedicaid