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Organization

CENTRAL PENINSULA GENERAL HOSPITAL

Active
Other names
Central Peninsula Pain Management
Organization subpart
No

Provider details

NPI number
Authorized official
RICHARD DAVIS (CEO)
(907) 714-4723
Entity
Organization

Contact information

Practice address
289 N FIREWEED ST, SUITE C, SOLDOTNA, AK 99669-7540
(907) 714-4075
Mailing address
289 N FIREWEED ST, SUITE C, SOLDOTNA, AK 99669-7540
(907) 714-4075

Taxonomy

Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
937105
AK
282NR1301X
Rural Acute Care Hospital
937105
AK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0004
TRICARE
01
155
BLUE CROSS
05
MDG830
AK
Enumeration date
11/30/2009
Last updated
05/20/2012
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