Provider Demographics
NPI:1992033153
Name:CENTRAL PENINSULA GENERAL HOSPITAL INC
Entity Type:Organization
Organization Name:CENTRAL PENINSULA GENERAL HOSPITAL INC
Other - Org Name:CENTRAL PENINSULA NEUROLOGY CLINIC
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:907-714-4090
Mailing Address - Fax:907-714-4697
Practice Address - Street 1:262 N BINKLEY ST
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669
Practice Address - Country:US
Practice Address - Phone:907-714-4090
Practice Address - Fax:907-714-4697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-30
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK9371062084N0400X, 282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No282NR1301XHospitalsGeneral Acute Care HospitalRuralGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0004OtherTRICARE
155OtherBLUE CROSS
AK1583121Medicaid
AK020024Medicare Oscar/Certification
0004OtherTRICARE