NPIMap

Organization Active NPI

Peacehealth

  • Surgery Physician
  • Ketchikan, AK
National Provider Identifier
1235556846
Registry record updated Mar 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
5790 Issued in AK
Legal business name
PEACEHEALTH
Practice address
212 Carlanna Lake Rd
#204
Ketchikan, AK 99901-5642
Phone
(907) 225-7346
NPI assigned
Mar 20, 2014
Last updated
Mar 20, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lori McCoy
Title
Provider Enrollment Specialist
Phone
(360) 729-1411

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 5790 AK Primary

Addresses

Primary practice location

212 Carlanna Lake Rd
#204
Ketchikan, AK 99901-5642

Mailing address

1115 SE 164TH Ave
Dept 358
Vancouver, WA 98683-9324
Phone (360) 729-1411

National Provider Directory

National Provider Directory
Tax ID family
Ketchikan General Hsptl5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

212 Carlanna Lake Rd
Ste 204
Ketchikan, AK 99901
Phone (907) 225-7346

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1395273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395273600000",
    "number": "1235556846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 SE 164TH AVE",
            "address_2": "DEPT 358",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986839324",
            "telephone_number": "360-729-1411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 CARLANNA LAKE RD",
            "address_2": "#204",
            "city": "KETCHIKAN",
            "state": "AK",
            "postal_code": "999015642",
            "telephone_number": "907-225-7346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACEHEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-20",
        "last_updated": "2014-03-20",
        "status": "A",
        "authorized_official_last_name": "MCCOY",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT SPECIALIST",
        "authorized_official_telephone_number": "360-729-1411"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AK",
            "license": "5790",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ketchikan, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.