Basic Information
| Provider Information | |||||||||
| NPI: | 1891793048 | ||||||||
| 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: | 9077471760 | ||||||||
| Practice Location | |||||||||
| Address1: | 209 MOLLER AVE | ||||||||
| Address2: | |||||||||
| City: | SITKA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 998357142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077473241 | ||||||||
| FaxNumber: | 9077471760 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2005 | ||||||||
| LastUpdateDate: | 11/29/2010 | ||||||||
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| AuthorizedOfficialLastName: | BENNETT | ||||||||
| AuthorizedOfficialFirstName: | LEE | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9077471764 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CITY OF SITKA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | SITKA COMMUNITY HOSP | AK | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | MS0047 | 05 | AK | MEDICAID | HH0569 | 05 | AK | MEDICAID |