Organization
CENTRAL PENINSULA GENERAL HOSPITAL INC
Active
Other names
Central Peninsula Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD DAVIS (CEO)
(907) 714-4723
Entity
Organization
Contact information
Practice address
506 LAKE ST, KENAI, AK 99611-6937
(907) 714-4030
(907) 335-0064
Mailing address
506 LAKE ST, KENAI, AK 99611-6937
(907) 714-4030
(907) 335-0064
Taxonomy
Speciality
Code
Description
License number
State
282NR1301X
Rural Acute Care Hospital
Primary
926294
AK
363A00000X
Physician Assistant
926294
AK
363LF0000X
Family Nurse Practitioner
926294
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004
TRICARE
AK
01
—
155
BLUE CROSS
AK
Enumeration date
02/27/2009
Last updated
12/07/2020
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