PETERSBURG MEDICAL CENTER (NPI# 1639237159) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639237159 |
| Entity Type | Organization |
| Organization Name | PETERSBURG MEDICAL CENTER |
| Other Organization Name | PETERSBURG GENERAL HOSPITAL |
| Practice Address |
103 Fram Street Petersburg AK 99833-0589 |
| Mailing Address |
Po Box 589 Petersburg AK 99833-0589 |
| Practice Telephone | 9077724291 |
| Practice Fax Number | 9077723085 |
| Mailing Telephone | 9077724291 |
| Mailing Fax Number | 9077723085 |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2008-06-10 |
| Authorized Official Name | JOHN BRINGHURST (CEO) |
| Authorized Official Telephone | 9077724291 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 313M00000X | Nursing Facility/Intermediate Care Facility | AK | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | HS09LT | 05 |
| Other Name | Type Code |
|---|---|
| Petersburg General Hospital | Former Legal Business Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972666345 | Petersburg Medical Center | Family Medicine | 103 Fram Street, Petersburg, AK 99833-0589 | 2006-12-18 |
| 1609936111 | Petersburg Medical Center | Registered Nurse | 103 Fram Street, Petersburg, AK 99833-0589 | 2006-12-12 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PETERSBURG MEDICAL CENTER | 103 Fram St, Petersburg, AK 99833-0000 |
| Street Address |
103 FRAM STREET |
| City | PETERSBURG |
| State | AK |
| Zip Code | 99833-0589 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437122843 | The Petersburg Medical Center | Family Medicine | 103 Fram Street, Petersburg, AK 99833-0589 | 2006-02-08 |
| 1760005037 | Stacie Mckinley | Physical Therapist | 103 Fram Street, Petersburg, AK 99833 | 2020-05-21 |
| 1063053353 | Molly Platt | Physical Therapist | 103 Fram Street, Petersburg, AK 99833 | 2019-10-08 |
| 1740737725 | Brian Oakes | Nurse Practitioner | 103 Fram Street, Petersburg, AK 99833-0589 | 2016-09-07 |
| 1013369206 | Elizabeth Poole | Nurse Practitioner | 103 Fram Street, Petersburg, AK 99833 | 2016-07-12 |
| 1457746109 | Erin Michael | Registered Nurse | 103 Fram Street, Petersburg, AK 99833-0377 | 2015-03-31 |
| 1538429964 | Kayla J. Luhrs | Family Medicine | 103 Fram Street, Petersburg, AK 99833 | 2012-05-18 |
| 1093082497 | Catherine G Wickert | Registered Nurse | 103 Fram Street, Petersburg, AK 99833-0589 | 2011-11-30 |
| 1659671949 | Candyce A Jones | Registered Nurse | 103 Fram Street, Petersburg, AK 99833-0589 | 2010-11-02 |
| 1407161706 | Laraine K Smith | Registered Nurse | 103 Fram Street, Petersburg, AK 99833-0589 | 2010-08-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831720713 | Southeast Alaska Regional Health Consortium | Community/Behavioral Health | 202 2nd & Gjoa Street, Petersburg, AK 99833 | 2020-01-30 |
| 1710518006 | Troy Carl Larson | Behavior Technician | 200 Fram Street, Petersburg, AK 99833 | 2020-01-27 |
| 1770128316 | Brenda Louise | Assisted Living Facility | 206 S 2nd, Petersburg, AK 99833 | 2019-11-07 |
| 1861055337 | Ashley Kawashima | Counselor | 100 Fram St., Petersburg, AK 99833 | 2019-04-19 |
| 1932762499 | Mindy Lopez | Rehabilitation Counselor | 1016 Lake Street, Petersburg, AK 99833 | 2019-04-19 |
| 1760921753 | Patrick Sessa | Social Worker | 201 N Nordic Dr., Petersburg, AK 99833 | 2017-02-23 |
| 1992151294 | Bradee Ann Luhr | Physical Therapist | 244 Mitkof Highway, Petersburg, AK 99833 | 2016-05-05 |
| 1891158267 | Lina Kotsoeva | Counselor | 226 S Nordic Dr, Petersburg, AK 99833 | 2016-04-01 |
| 1447623137 | Pacific Wings, LLC | Air Carrier | 1500 Haugen Drive, Petersburg, AK 99833 | 2015-11-04 |
| 1366857088 | Amanda Lemiere Taylor | Social Worker | 201 N Nordic Dr, Petersburg, AK 99833 | 2014-06-23 |
| Find all providers in zip 99833 | ||||
| Taxonomy Code | 313M00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Nursing Facility/Intermediate Care Facility |
| An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals. |
| Notes: Source: Paraphrased from Section 1919 (a) of the Social Security Act. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932312485 | South East Alaska Regional Health Consortium | Nursing Facility/Intermediate Care Facility | 2000 Salmon Creek Lane, 2000 Salmon Creek Lane, Juneau, AK 99801-7801 | 2007-05-08 |
| 1275751307 | Elenas Place II Corp. | Nursing Facility/Intermediate Care Facility | 8611 #1 Arctic Boulevard, Anchorage, AK 99515 | 2007-04-23 |
| 1629198403 | Norton Sound Health Corp | Nursing Facility/Intermediate Care Facility | 306 W 5th Street, Nshc, Nome, AK 99762 | 2007-03-29 |
| 1023106606 | Heritage Place | Nursing Facility/Intermediate Care Facility | 232 W Rockwell Ave, Soldotna, AK 99669-7411 | 2006-10-10 |
| 1922036060 | Central Peninsula General Hospital, Inc | Nursing Facility/Intermediate Care Facility | 232 Rockwell, Soldotna, AK 99669 | 2006-06-29 |
| 1528477494 | Brent Lannen | Nursing Facility/Intermediate Care Facility | 9100 Centennial Cir, Anchorage, AK 99504-1480 | 2014-08-05 |
| 1386814473 | South East Alaska Regional Health Consortium | Nursing Facility/Intermediate Care Facility | 120 Katlian St, Sitka, AK 99835-7525 | 2008-03-05 |
| 1831368661 | Tanana Chiefs Conference | Nursing Facility/Intermediate Care Facility | 1408 19th Ave, Fairbanks, AK 99701-5903 | 2008-02-26 |
| 1366658858 | Providence Health & Services Washington | Nursing Facility/Intermediate Care Facility | 1915 E Rezanof Dr, Kodiak, AK 99615-6602 | 2007-05-14 |
| City | PETERSBURG |
| Zip Code | 99833 |
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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.