PROVIDENCE HEALTH & SERVICES WASHINGTON NPI 1952430902

NPI Information

NPI: 1952430902
Provider Name: PROVIDENCE HEALTH & SERVICES WASHINGTON

Doing Business As: PROVIDENCE KODIAK ISLAND MEDICAL CENTER

Classification: Emergency Medicine - 207PE0004X
Entity Type: Organization

Specialization: Emergency Medical Services

Address:
1915 E REZANOF DR
KODIAK, AK
ZIP 99615
Phone: (907) 486-3281
Get Directions

PROVIDENCE HEALTH & SERVICES WASHINGTON is an emergency medical services emergency medicine in Kodiak, AK. The provider is an emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients. PROVIDENCE HEALTH & SERVICES WASHINGTON NPI is 1952430902. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Providence Kodiak Island Medical Center.

The provider's business location address is:

1915 E REZANOF DR
KODIAK, AK
ZIP 99615-602
Phone: (907) 486-3281

The provider's authorized official is Donald Wayne Anderson .
The authorized official title is Asst Corp Secretary For Enrollments and has the following contact phone number (425) 525-5392.

The enumeration date for this NPI number is 3/5/2007 and was last updated on 7/22/2019.

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	208M00000X	Hospitalist				No
2	282NC0060X	General Acute Care Hospital	Critical Access	309115	ALASKA	No
3	207PE0004X	Emergency Medicine	Emergency Medical Services			Yes

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	MDG191	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: 4/28/2024

NPI Synchronization or Removal

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