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NPI 1952430902

OrganizationActive

Providence Health & Services Washington

NPI 1952430902 · Emergency Medical Services (Emergency Medicine) Physician · Kodiak, AK

Provider details

NPI number: 1952430902
Entity type: Organization
Primary specialty: Emergency Medical Services (Emergency Medicine) PhysicianAllopathic & Osteopathic Physicians
Organization subpart: No
Authorized official: Donald Anderson, Assistant Secretary of Enrollments(425) 358-9786

Specialties & taxonomies

Emergency Medical Services (Emergency Medicine) PhysicianPrimary207PE0004X
Allopathic & Osteopathic Physicians
Hospitalist Physician208M00000X
Allopathic & Osteopathic Physicians
Critical Access Hospital282NC0060XLicense 309115 (AK)
Hospitals

Practice location

1915 E Rezanof Dr

Kodiak, AK 99615-6602

Phone: (907) 486-3281

Approximate (ZIP-level) locationGet directions

More AK providers

Mailing address

Po Box 3706

Portland, OR 97208-3706

Other names (DBA / former)

Doing business as: Providence Kodiak Island Medical Center
Doing business as: Providence Kodiak Island Medical Center

Registry dates

Enumerated: 2007-03-05
Last updated: 2025-05-13
Certified: 2025-05-13

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.

Providence Health & Services Washington — NPI 1952430902, Kodiak, AK | NPI Central