PROVIDENCE HEALTH & SERVICES WASHINGTON


Address: 1915 E Rezanof Dr, Kodiak, AK 99615-6602
Phone: 9074863281

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).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 282NC0060X General Acute Care Hospital
Specialization: Critical Access
309115 AK Hospitals

Other Provider Identifier

State Issuer Identifier Type Code
AK HS10 05

Other Provider/Organization Names

Other Name Type Code
Providence Kodiak Island Medical Center Doing Business As Name - Organization

Other Provider IDs and Locations

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

Office Location

Street Address 1915 E REZANOF DR
City KODIAK
State AK
Zip Code 99615-6602

Providers in the same location

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
Find all providers in the same location

Providers in the same zip code

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 Information

Taxonomy Code 282NC0060X
Grouping Hospitals
Classification General Acute Care Hospital
Specialization Critical Access

Taxonomy Definition

Definition to come.
Notes: [7/1/2003: new]

Providers in the same taxonomy and state

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
Find all providers with the same taxonomy

Competitor

Search similar providers

City KODIAK
Zip Code 99615

Improve Information

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Dataset Information

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.

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