Provider Demographics
NPI:1639494263
Name:CENTRAL PENINSULA GENERAL HOSPITAL INC
Entity Type:Organization
Organization Name:CENTRAL PENINSULA GENERAL HOSPITAL INC
Other - Org Name:CENTRAL PENINSULA ORTHOPEDICS
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:907-714-4120
Mailing Address - Fax:907-714-4696
Practice Address - Street 1:240 HOSPITAL PL
Practice Address - Street 2:STE 204
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7559
Practice Address - Country:US
Practice Address - Phone:907-714-4120
Practice Address - Fax:907-714-4696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK941255282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK155OtherBLUE CROSS
AK0004OtherTRIWEST
AKMDG830Medicaid
AK0004OtherTRIWEST
AK020024Medicare Oscar/Certification