Basic Information
| Provider Information | |||||||||
| NPI: | 1982957015 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROVIDENCE MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 365 | ||||||||
| Address2: | |||||||||
| City: | SEWARD | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996640365 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 417 FIRST AVE | ||||||||
| Address2: | |||||||||
| City: | SEWARD | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996640365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9072245205 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2012 | ||||||||
| LastUpdateDate: | 10/26/2012 | ||||||||
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| AuthorizedOfficialLastName: | BEALS | ||||||||
| AuthorizedOfficialFirstName: | PATRICIA | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | REHAB SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 9072242803 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0400X | 2310 | AK | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
No ID Information.