PROVIDENCE HEALTH & SERVICES WASHINGTON (NPI# 1013905660) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1013905660 |
Entity Type | Organization |
Organization Name | PROVIDENCE HEALTH & SERVICES WASHINGTON |
Other Organization Name | PROVIDENCE KODIAK ISLAND MEDICAL CENTER |
Practice Address |
1915 E Rezanof Dr Kodiak AK 99615-6602 |
Mailing Address |
Po Box 3706 Portland OR 97208-3706 |
Practice Telephone | 9074863281 |
Practice Fax Number | 9074869546 |
Mailing Telephone | 9074863281 |
Mailing Fax Number | 9074869546 |
Enumeration Date | 2005-10-07 |
Last Update Date | 2019-02-15 |
Authorized Official Name | DONALD WAYNE ANDERSON JR. (DIR REIMB ADMIN & ASST SEC ENROLLMT) |
Authorized Official Telephone | 4255255392 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 282NC0060X |
General Acute Care Hospital Specialization: Critical Access |
309115 | AK | Hospitals |
State | Issuer | Identifier | Type Code |
---|---|---|---|
AK | HS10 | 05 |
Other Name | Type Code |
---|---|
Providence Kodiak Island Medical Center | Doing Business As Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1134656135 | Providence Health & Services Washington | Clinic/Center | 1018 Capitol Way S Ste 300, Olympia, WA 98501-1212 | 2017-05-22 |
1023550050 | Providence Health & Services Washington | Psychologist | 225 State Ave Ne, Olympia, WA 98501-6951 | 2016-11-08 |
1003367863 | Providence Health & Services Washington | Radiology | 4800 College St Se Ste E, Lacey, WA 98503-4389 | 2016-10-17 |
1023563897 | Providence Health & Services Washington | Clinic/Center | 1705 Se Meadowbrook Blvd, Suite 2, College Place, WA 99324-1756 | 2016-08-22 |
1457721250 | Providence Health & Services Washington | Clinic/Center | 1200 Basich Blvd, Aberdeen, WA 98520-1035 | 2015-10-06 |
1902141500 | Providence Health & Services Washington | Clinical Medical Laboratory | 820 S Mcclellan St Ste Ll10, Spokane, WA 99204-2446 | 2012-12-07 |
1881907715 | Providence Health & Services Washington | Internal Medicine | 62 W 7th Ave, Spokane, WA 99204-2321 | 2010-07-20 |
1073744850 | Providence Health & Services Washington | Rehabilitation, Substance Use Disorder Unit | 2505 Olympic Hwy N., Ste 140, Shelton, WA 98584-2978 | 2009-07-28 |
1770714693 | Providence Health & Services Washington | Rehabilitation, Substance Use Disorder Unit | 508 1/2 Eighth Street, Hoquiam, WA 98550-3521 | 2009-07-28 |
1033309604 | Providence Health & Services Washington | Family Medicine | 1450 Northwest Lane Se, Lacey, WA 98503-6908 | 2007-07-30 |
Street Address |
1915 E REZANOF DR |
City | KODIAK |
State | AK |
Zip Code | 99615-6602 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1093228348 | Stephanie Louise Hurley | Pharmacist | 1915 E Rezanof Dr, Kodiak, AK 99615-6602 | 2017-11-08 |
1083125355 | Kodiak Life Diagnostic Imaging, Inc | Clinic/Center | 1915 E Rezanof Dr, Kodiak, AK 99615-6602 | 2017-10-13 |
1639555840 | Aurora Crye | Pharmacist | 1915 E Rezanof Dr, Kodiak, AK 99615 | 2015-08-11 |
1144666918 | John Arthur Mcentee | Pharmacist | 1915 E Rezanof Dr, Kodiak, AK 99615-6602 | 2013-05-20 |
1508150384 | Diana Bash | Registered Nurse | 1915 E Rezanof Dr, Kodiak, AK 99615-6602 | 2011-06-08 |
1235421132 | Monique Patricia Reckner | Registered Nurse | 1915 E Rezanof Dr, Kodiak, AK 99615-6602 | 2011-05-10 |
1295032910 | Kodiak Board Certified Radiology, LLC | Radiology | 1915 E Rezanof Dr, Kodiak, AK 99615-6602 | 2011-02-15 |
1306147434 | Providence Kodiak Medical Center | Custodial Care Facility | 1915 E Rezanof Dr, Kodiak, AK 99615-6602 | 2010-11-05 |
1194032631 | Amy Jean Deer | Registered Nurse | 1915 E Rezanof Dr, Kodiak, AK 99615-6602 | 2010-09-03 |
1437463601 | Louisa Gayle Solesbee | Registered Nurse | 1915 E Rezanof Dr, Kodiak, AK 99615-6602 | 2010-07-30 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1144864232 | Linda Irene Dunlap | Spec/Tech, Pathology | 1915 E. Remanof Drive, Kodiak, AK 99615 | 2019-10-31 |
1639638190 | Stephanie Brenteson | Community Health Worker | 125 Airport Way, Akhiok, AK 99615 | 2019-03-14 |
1609351022 | Desiree Alexis Wheeler | Optometrist | 3450 E Rezanof Dr, Kodiak, AK 99615 | 2018-10-02 |
1417479072 | Elaine Loomis Olsen | Case Manager/Care Coordinator | 1111 Purtov St., Kodiak, AK 99615 | 2017-07-14 |
1750828414 | Mary Jean Francisco | Case Manager/Care Coordinator | 717 East Rezanof Drive, Kodiak, AK 99615 | 2017-01-19 |
1558818112 | Carolyn Hawes | Case Manager/Care Coordinator | 717 Rezanof Dr, Kodiak, AK 99615 | 2016-09-01 |
1285083683 | Amanda Wilson | Community Health Worker | 124 Akhiok Street, Akhiok, AK 99615 | 2016-06-07 |
1447612056 | Kailee Champion | Massage Therapist | 3449 Rezanof Drive East, Kodiak, AK 99615 | 2016-03-23 |
1376891069 | Krystyna Mcrobert | Technician, Other | Cape Sarichef Road Bldg N46, Rockmore King Clinic, Kodiak, AK 99615 | 2012-08-28 |
1164778619 | Mark Anthony Johnson | Pharmacist | 3449 Rezanof Drive, Kodiak, AK 99615 | 2012-08-01 |
Find all providers in zip 99615 |
Taxonomy Code | 282NC0060X |
Grouping | Hospitals |
Classification | General Acute Care Hospital |
Specialization | Critical Access |
Definition to come. |
Notes: [7/1/2003: new] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1295855666 | Norton Sound Health Corp | General Acute Care Hospital | Nshc, 306 W 5th, Nome, AK 99762 | 2007-03-30 |
1306933643 | Arctic Slope Native Association Ltd | General Acute Care Hospital | 7000 Uula Street, Barrow, AK 99723 | 2006-10-06 |
1518955731 | Wrangell Medical Center | General Acute Care Hospital | 310 Bennett Street, Wrangell, AK 99929-1081 | 2005-10-11 |
1871996975 | Norton Sound Health Corp Physical Teraphy | General Acute Care Hospital | 1000 Greg Kruschek Ave, Nome, AK 99762 | 2014-10-02 |
1780085381 | Sitka Community Hospital | General Acute Care Hospital | 209 Moller Ave, Sitka, AK 99835-7142 | 2014-09-15 |
1588902027 | Norton Sound Health Corp | General Acute Care Hospital | 1000 Greg Kruschek Ave, Nome, AK 99762 | 2013-01-17 |
1487898110 | Searhc Mt Edcumbe Hospital | General Acute Care Hospital | 222 Tongass Dr, Sitka, AK 99835-9416 | 2009-04-24 |
1962688309 | Bristol Bay Area Health Corporation | General Acute Care Hospital | 6000 Kanakanak Rd, Dillingham, AK 99576-0130 | 2008-01-16 |
1578758744 | Samuel Simmonds Memorial Hospital | General Acute Care Hospital | 1296 Agvik Street, Barrow, AK 99723-0029 | 2007-09-11 |
1326230756 | Asna-samuel Simmonds Memorial Hospital | General Acute Care Hospital | 1296 Agvik Street, Barrow, AK 99723-0029 | 2007-08-09 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.