SOUTH PENINSULA HOSPITAL, INC. (NPI# 1679566269) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679566269 |
| Entity Type | Organization |
| Organization Name | SOUTH PENINSULA HOSPITAL, INC. |
| Practice Address |
4300 Bartlett Street Homer AK 99603-7005 |
| Practice Telephone | 9072358101 |
| Practice Fax Number | 9072350253 |
| Mailing Telephone | 9072358101 |
| Mailing Fax Number | 9072350253 |
| Enumeration Date | 2005-08-29 |
| Last Update Date | 2020-02-07 |
| Authorized Official Name | MR. RYAN SMITH (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 9072350241 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207PE0004X |
Emergency Medicine Specialization: Emergency Medical Services |
Allopathic & Osteopathic Physicians | ||
| N | 207X00000X | Orthopaedic Surgery | Allopathic & Osteopathic Physicians | ||
| N | 208600000X | Surgery | Allopathic & Osteopathic Physicians | ||
| N | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities | ||
| Y | 282NC0060X |
General Acute Care Hospital Specialization: Critical Access |
Hospitals |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | 1005654 | 05 | |
| AK | 1028527 | 05 | |
| AK | 1582637 | 05 | |
| AK | 1005653 | 05 | |
| AK | 1005186 | 05 | |
| AK | 1020634 | 05 | |
| AK | 1701931 | 05 | |
| AK | 1582664 | 05 | |
| AK | 1687518 | 05 | |
| AK | 1687514 | 05 |
| Street Address |
4300 BARTLETT STREET |
| City | HOMER |
| State | AK |
| Zip Code | 99603-7005 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073899266 | Heidi J Smith | Registered Nurse | 4300 Bartlett Street, C/o Sph- Homehealth, Homer, AK 99603 | 2011-11-01 |
| 1770785578 | Noreen Jacqueline Zavorsky | Occupational Therapist | 4300 Bartlett Street, Occupational Physical Therapy Dept South Peninsula Hosp, Homer, AK 99603 | 2007-06-04 |
| 1164636015 | Emilie Annette Otis | Physical Therapy Assistant | 4300 Bartlett Street, Homer, AK 99603 | 2007-05-10 |
| 1871617225 | William Stephan Roberts | Radiology | 4300 Bartlett Street, South Peninsula Hospital, Homer, AK 99603 | 2007-03-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518572387 | Morgan Dwyer | Counselor | 51310 Timber Bay Ct, Homer, AK 99603 | 2020-09-09 |
| 1346859824 | John George Hetrick | Counselor | 51310 Timber Bay Ct., Homer, AK 99603 | 2020-07-30 |
| 1093352502 | Katieostrommd | Obstetrics & Gynecology | 205 W Fairview, Homer, AK 99603 | 2019-12-03 |
| 1023651965 | Melissa Elizabeth Malcolm | Physical Therapy Assistant | 4107 Hohe Ave, Homer, AK 99603 | 2019-10-23 |
| 1184143620 | Homer Birth and Wellness Center | Clinic/Center | 3902 Shelford Street, Homer, AK 99603 | 2017-09-15 |
| 1588913271 | Sharon Marie Gorman | Registered Nurse | 3959 Ben Walters, Homer, AK 99603 | 2012-09-10 |
| 1477802197 | Aldergrove Assisted Living | Community Based Residential Treatment Facility, Mental Illness | 41045 Denny Lane, Homer, AK 99603 | 2012-09-10 |
| 1194087551 | Stephen Michael Mueller | Pharmacist | 3858 Lake Street, Suite #5, Lakeside Mall, Homer, AK 99603 | 2012-06-12 |
| 1962778001 | Homer Dental Center Inc | Dentist | 4014 Lake St., Ste 210, Homer, AK 99603 | 2012-03-22 |
| 1346544368 | William R Easton | General Practice | 2495 Bayridge Rd, Homer, AK 99603 | 2011-01-05 |
| Find all providers in zip 99603 | ||||
| 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 |
| 1013905660 | Providence Health & Services Washington | General Acute Care Hospital | 1915 E Rezanof Dr, Kodiak, AK 99615-6602 | 2005-10-07 |
| 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 |
| Find all providers with the same taxonomy | ||||
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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.