Basic Information
| Provider Information | |||||||||
| NPI: | 1780085381 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SITKA COMMUNITY HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 209 MOLLER AVE | ||||||||
| Address2: | |||||||||
| City: | SITKA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 998357142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077473241 | ||||||||
| FaxNumber: | 9077470351 | ||||||||
| Practice Location | |||||||||
| Address1: | 209 MOLLER AVE | ||||||||
| Address2: | |||||||||
| City: | SITKA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 998357142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077473241 | ||||||||
| FaxNumber: | 9077470351 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2014 | ||||||||
| LastUpdateDate: | 09/15/2014 | ||||||||
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| AuthorizedOfficialLastName: | BENNETT | ||||||||
| AuthorizedOfficialFirstName: | LEE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9077471764 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | AK | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 1005674 | 05 | AK | MEDICAID | K0000ZGBJW | 01 | AK | MEDICARE PART B PROVIDER NUMBER | OTHER | 021303 | 01 | AK | MEDICARE PART A PROVIDER # | OTHER | 1020625 | 05 | AK | MEDICAID |