Organization
CENTRAL PENINSULA GENERAL HOSPITAL
Active
Other names
CENTRAL PENINSULA PEDIATRICS
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RYAN K SMITH (CEO)
(907) 714-4718
Entity
Organization
Contact information
Practice address
289 N. FIREWEED STREET, SUITE C, SOLDOTNA, AK 99669-7540
(907) 714-4045
Mailing address
289 N. FIREWEED STREET, SUITE C, SOLDOTNA, AK 99669-7540
(907) 714-4045
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
928993
AK
282NR1301X
Rural Acute Care Hospital
Primary
928993
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004
TRIWEST
AK
01
—
155
BLUE CROSS
AK
Enumeration date
05/18/2009
Last updated
08/11/2009
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