Organization
SOUTH PENINSULA HOSPITAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RYAN SMITH (CHIEF EXECUTIVE OFFICER)
(907) 235-0241
Entity
Organization
Contact information
Practice address
4300 BARTLETT STREET, HOMER, AK 99603-7005
(907) 235-8101
(907) 235-0253
Mailing address
4300 BARTLETT STREET, HOMER, AK 99603-7005
(907) 235-8101
(907) 235-0253
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
208600000X
Surgery Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
282NC0060X
Critical Access Hospital
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1005186
—
AK
05
—
1005653
—
AK
05
—
1005654
—
AK
05
—
1020634
—
AK
05
—
1028527
—
AK
05
—
1582637
—
AK
05
—
1582664
—
AK
05
—
1687514
—
AK
05
—
1687518
—
AK
05
—
1701931
—
AK
Enumeration date
08/29/2005
Last updated
02/07/2020
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