Basic Information
| Provider Information | |||||||||
| NPI: | 1528062429 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CENTRAL PENINSULA GENERAL HOSPITAL INC. | ||||||||
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| OtherOrganizationName: | CENTRAL PENINSULA HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 HOSPITAL PL | ||||||||
| Address2: | |||||||||
| City: | SOLDOTNA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996697559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077144404 | ||||||||
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| Practice Location | |||||||||
| Address1: | 250 HOSPITAL PL | ||||||||
| Address2: | |||||||||
| City: | SOLDOTNA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996697559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077144404 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2005 | ||||||||
| LastUpdateDate: | 02/25/2012 | ||||||||
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| AuthorizedOfficialLastName: | DAVIS | ||||||||
| AuthorizedOfficialFirstName: | RICK | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9077144723 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 275N00000X | 227830 | AK | N | Hospital Units | Medicare Defined Swing Bed Unit | 276400000X | 311489 | AK | N | Hospital Units | Rehabilitation, Substance Use Disorder Unit | 261QM0801X | 227830 | AK | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 282NR1301X | 227830 | AK | Y | Hospitals | General Acute Care Hospital | Rural |
ID Information
| ID | Type | State | Issuer | Description | 155 | 01 | AK | BLUE CROSS | OTHER | MS7723 | 05 | AK | MEDICAID | HS01IP | 05 | AK | MEDICAID | 0004 | 01 | AK | TRICARE | OTHER | HS01OP | 05 | AK | MEDICAID | DA7523 | 05 | AK | MEDICAID | MDG830 | 05 | AK | MEDICAID | HS01SB | 05 | AK | MEDICAID |