Basic Information
| Provider Information | |||||||||
| NPI: | 1487815254 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CENTRAL PENINSULA GENERAL HOSPITAL | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 250 HOSPITAL PL | ||||||||
| Address2: | |||||||||
| City: | SOLDOTNA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996697559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077144515 | ||||||||
| FaxNumber: | 9077144696 | ||||||||
| Practice Location | |||||||||
| Address1: | 250 HOSPITAL PL | ||||||||
| Address2: | |||||||||
| City: | SOLDOTNA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996697559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077144515 | ||||||||
| FaxNumber: | 9077144696 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2008 | ||||||||
| LastUpdateDate: | 06/24/2008 | ||||||||
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| AuthorizedOfficialLastName: | ANDERSON | ||||||||
| AuthorizedOfficialFirstName: | MARCIA | ||||||||
| AuthorizedOfficialMiddleName: | ELICE | ||||||||
| AuthorizedOfficialTitleorPosition: | CLINICAL DIETITIAN | ||||||||
| AuthorizedOfficialTelephone: | 9077144752 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | RD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 196 | AK | Y | Hospitals | General Acute Care Hospital |
No ID Information.