PENINSULA COMMUNITY HEALTH SERVICES OF ALASKA INC. NPI 1700984614

NPI Information

NPI: 1700984614
Provider Name: PENINSULA COMMUNITY HEALTH SERVICES OF ALASKA, INC.
Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

CLIA Number: 02D0951956

Address:
230 E MARYDALE AVE
SOLDOTNA, AK
ZIP 99669
Phone: (907) 260-7300
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PENINSULA COMMUNITY HEALTH SERVICES OF ALASKA, INC. is a federally qualified health center (fqhc) clinic center in Soldotna, AK. PENINSULA COMMUNITY HEALTH SERVICES OF ALASKA, INC. NPI is 1700984614. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

230 E MARYDALE AVE
SOLDOTNA, AK
ZIP 99669-648
Phone: (907) 260-7300
Fax: (907) 260-7301

The provider's authorized official is Jeffrey Magee .
The authorized official title is Cmo and has the following contact phone number (907) 260-7300.

The CLIA number assigned to this NPI record is 02D0951956 - federally qualified health center with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 9/21/2006 and was last updated on 8/5/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	737	ALASKA	No
2	174400000X	Specialist		2093	ALASKA	No
3	363AM0700X	Physician Assistant	Medical	706967	ALASKA	No
4	363LC1500X	Nurse Practitioner	Community Health	706967	ALASKA	No
5	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)	703967	ALASKA	Yes
6	122300000X	Dentist		706967	ALASKA	No
7	103TC0700X	Psychologist	Clinical	706967	ALASKA	No
8	207Q00000X	Family Medicine		706967	ALASKA	No
9	1041C0700X	Social Worker	Clinical	706967	ALASKA	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	HC5786	OTHER	ALASKA	MEDICAID PROJECT CHOICE
2	021819	MEDICARE OSCAR/CERTIFICATION	ALASKA
3	DDG26FQ	MEDICAID	ALASKA
4	RH177FQ	MEDICAID	ALASKA
5	0000WCGTW	MEDICARE PIN	ALASKA
6	K162666	OTHER	ALASKA	MEDICARE PTAN
7	MH0156	MEDICAID	ALASKA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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