Provider Demographics
NPI:1013791227
Name:CENTRAL PENINSULA GENERAL HOSPITAL, INC
Entity Type:Organization
Organization Name:CENTRAL PENINSULA GENERAL HOSPITAL, INC
Other - Org Name:CENTRAL PENINSULA ENDOCRINOLOGY AND DIABETES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JON
Authorized Official - Last Name:HAGGERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-714-4722
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:907-714-4726
Mailing Address - Fax:
Practice Address - Street 1:209 W KATMAI AVE
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7409
Practice Address - Country:US
Practice Address - Phone:907-714-4726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL PENINSULA GENERAL HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-21
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty