Provider Demographics
NPI:1750485488
Name:CITY OF VALDEZ
Entity Type:Organization
Organization Name:CITY OF VALDEZ
Other - Org Name:PROVIDENCE VALDEZ MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CITY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOZEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-835-4313
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:VALDEZ
Mailing Address - State:AK
Mailing Address - Zip Code:99686-0550
Mailing Address - Country:US
Mailing Address - Phone:907-835-2249
Mailing Address - Fax:907-834-1890
Practice Address - Street 1:911 MEALS
Practice Address - Street 2:
Practice Address - City:VALDEZ
Practice Address - State:AK
Practice Address - Zip Code:99686-0550
Practice Address - Country:US
Practice Address - Phone:907-835-2249
Practice Address - Fax:907-834-1890
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF VALDEZ
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-12
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
AK282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHS027OPMedicaid
AKHS027IPMedicaid
AK02-1301Medicare Oscar/Certification