PEACEHEALTH (NPI# 1396705539) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396705539 |
| Entity Type | Organization |
| Organization Name | PEACEHEALTH |
| Other Organization Name | KETCHIKAN MEDICAL CENTER |
| Practice Address |
3100 Tongass Ave Ketchikan AK 99901-5746 |
| Mailing Address |
Po Box 1798 Bellingham WA 98227-1798 |
| Practice Telephone | 9072288300 |
| Practice Fax Number | 9072288518 |
| Mailing Telephone | 3607345400 |
| Mailing Fax Number | 3607156552 |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2011-08-31 |
| Authorized Official Name | PATRICK J BRANCO (CEO) |
| Authorized Official Telephone | 9072288300 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 282NC0060X |
General Acute Care Hospital Specialization: Critical Access |
NO NUMBER ASSIGN | AK | Hospitals |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | AETNA FACILITY ID | 6110165 | 01 |
| AK | HS04OP | 05 | |
| AK | TRICARE GROUP NUMBER | 0025 | 01 |
| AK | HS04IP | 05 |
| Other Name | Type Code |
|---|---|
| Ketchikan Medical Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255977591 | Peacehealth | Durable Medical Equipment & Medical Supplies | 625 9th Ave Ste 120, Longview, WA 98632-2465 | 2019-11-21 |
| 1184106437 | Peacehealth | Durable Medical Equipment & Medical Supplies | Triangle Mall Suite 16 1015 Ocean Beach Hwy, Longview, WA 98632 | 2018-09-04 |
| 1669766457 | Peacehealth | General Acute Care Hospital | 787 Woodland Acres Ln, Eugene, OR 97402-9378 | 2011-06-09 |
| 1760427082 | Peacehealth | Home Health | 126 Washington St, Ketchikan, AK 99901-5930 | 2006-06-19 |
| 1912957986 | Peacehealth | Clinical Medical Laboratory | 123 International Way, Springfield, OR 97477-1047 | 2006-05-11 |
| 1083672273 | Peacehealth | Rehabilitation Unit | 809 E Chestnut St, Bellingham, WA 98225-5221 | 2006-05-04 |
| 1447217559 | Peacehealth | Hospice, Inpatient | 2800 Douglas Avenue, Bellingham, WA 98225 | 2006-05-01 |
| 1215918719 | Peacehealth | Hospice Care, Community Based | 2230 Kingwood Street, Florence, OR 97439-9470 | 2005-11-10 |
| 1225019011 | Peacehealth | Home Health | 2230 Kingwood St, Florence, OR 97439-9464 | 2005-11-08 |
| 1346237971 | Peacehealth | General Acute Care Hospital | 1255 Hilyard St, Eugene, OR 97401-3718 | 2005-09-29 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PEACEHEALTH | 1115 Se 164th Avenue, Vancouver, WA 98683-9324 |
| Washington State Corporations | PEACEHEALTH | 1115 Se 164th Ave Dept. 302, Vancouver, WA 98683 |
| Oregon Corporations, Companies and Business Names | PEACEHEALTH | 1115 Se 164th Ave Dept 302, Vancouver, WA 98683 |
| Oregon Corporations, Companies and Business Names | PEACEHEALTH - COTTAGE GROVE | 1515 Village Dr, Cottage Grove, OR 97424 |
| Washington State Corporations | PEACEHEALTH ASC BELLINGHAM, LLC | 1115 Se 164th Ave, Dept 302, Vancouver, WA 98683-9324 |
| Oregon Corporations, Companies and Business Names | PEACEHEALTH COTTAGE GROVE COMMUNITY MEDICAL CENTER | 1515 Village Dr, Cottage Grove, OR 97424 |
| Oregon Corporations, Companies and Business Names | PEACEHEALTH COTTAGE GROVE COMMUNITY MEDICAL CENTER FOUNDATION | 1515 Village Dr, Cottage Grove, OR 97424 |
| Oregon Corporations, Companies and Business Names | PEACEHEALTH COTTAGE GROVE COMMUNITY MEDICAL CENTER SWING | 1515 Village Drive, Cottage Grove, OR 97424 |
| Oregon Corporations, Companies and Business Names | PEACEHEALTH HOSPITAL MEDICINE | 3333 Riverbend Dr, Springfield, OR 97477 |
| Oregon Corporations, Companies and Business Names | PEACEHEALTH LABORATORIES | 123 International Way, Springfield, OR 97477 |
| Street Address |
3100 TONGASS AVE |
| City | KETCHIKAN |
| State | AK |
| Zip Code | 99901-5746 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194720250 | Alan L Christensen | Obstetrics & Gynecology | 3100 Tongass Ave, Ketchikan, AK 99901-5746 | 2005-06-16 |
| 1528544822 | Peacehealth Ketchikan Medical Center | Medicare Defined Swing Bed Unit | 3100 Tongass Ave, Ketchikan, AK 99901-5746 | 2018-07-19 |
| 1710337381 | Ian Dobbe | Family Medicine | 3100 Tongass Ave, Ketchikan, AK 99901-5746 | 2016-06-15 |
| 1073977443 | Michael Sheflo | Internal Medicine | 3100 Tongass Ave, Ketchikan, AK 99901-5746 | 2016-04-11 |
| 1598144800 | Bryan Cothren | Psychiatry & Neurology | 3100 Tongass Ave, Ketchikan, AK 99901 | 2015-05-20 |
| 1093145567 | Catherine Henderson | Nurse Practitioner | 3100 Tongass Ave, Ketchikan, AK 99901-5746 | 2013-11-20 |
| 1003169434 | Urology Northwest, Ps | Urology | 3100 Tongass Ave, 3rd Floor Visiting Clinic, Ketchikan, AK 99901-5746 | 2012-10-23 |
| 1821374497 | Deborah M O'loane | Nurse Practitioner | 3100 Tongass Ave, Ketchikan, AK 99901-5746 | 2011-10-27 |
| 1215239595 | Nes Washington, Inc. | Emergency Medicine | 3100 Tongass Ave, Ketchikan, AK 99901 | 2010-11-19 |
| 1447562921 | Victor Chen | Psychiatry & Neurology | 3100 Tongass Ave, Ketchikan, AK 99901-5746 | 2010-07-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992314215 | Residential Youth Care, Inc. | Community/Behavioral Health | 2442 Tongass Avenue, Ketchikan, AK 99901 | 2020-07-23 |
| 1316563026 | Residential Youth Care, Inc. | Community/Behavioral Health | 606 Hill Road, Ketchikan, AK 99901 | 2020-06-18 |
| 1043836851 | Residential Youth Care, Inc. | Community/Behavioral Health | 2514 1st Avenue, Ketchikan, AK 99901 | 2020-06-18 |
| 1215553029 | Residential Youth Care, Inc. | Community/Behavioral Health | 2951 Baranof Avenue, Ketchikan, AK 99901 | 2020-06-18 |
| 1174159222 | Helene Rae Simpson | Behavior Technician | 201 Deermont St, Ketchikan, AK 99901 | 2020-03-20 |
| 1003295155 | Suzanne Webb | Massage Therapist | 602 Dock St Ste 106, Ketchikan, AK 99901 | 2015-05-22 |
| 1093194342 | Kate Mortensen | Case Manager/Care Coordinator | 2690 Tongass Ave, Ketchikan, AK 99901 | 2015-05-20 |
| 1578879631 | Thomas Peter Ryan | Social Worker | 320 Bawden St. #318, Ketchikan, AK 99901 | 2010-08-27 |
| 1689820979 | Akeela Inc | Community Based Residential Treatment Facility, Mental Illness | 3050 Fifth Ave, Ketchikan, AK 99901 | 2008-08-18 |
| 1750565438 | Susan Marie Swift | Nurse Practitioner | 21 Jefferson Way, Suite 202, Psychiatry, Ketchikan, AK 99901 | 2007-12-18 |
| Find all providers in zip 99901 | ||||
| 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 |
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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.