NPIMap

Organization Active NPI

Providence Health & Services - Washington

Doing business as Providence Kodiak Island Medical Center

  • Skilled Nursing Facility
  • Kodiak, AK
National Provider Identifier
1982708699
Registry record updated May 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
309115 Issued in AK
Legal business name
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Doing business as
Providence Kodiak Island Medical Center
Practice address
1915 E Rezanof Dr
Kodiak, AK 99615-6602
Phone
(907) 486-3281
Fax
(907) 486-9546
NPI assigned
Sep 12, 2006
Last updated
May 13, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2025

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

Authorized official

Name
Donald W Anderson Jr.
Title
Assistant Secretary of Enrollments
Phone
(425) 358-9786

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 309115 AK Primary

Addresses

Primary practice location

1915 E Rezanof Dr
Kodiak, AK 99615-6602

Mailing address

PO Box 3706
Portland, OR 97208-3706
Phone (907) 486-3281

Other names 1

  • Providence Kodiak Island Medical Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pkimc Home Health8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

NPI Registry JSON

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

{
    "created_epoch": "1158019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747094400000",
    "number": "1982708699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3706",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083706",
            "telephone_number": "907-486-3281",
            "fax_number": "907-486-9546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1915 E REZANOF DR",
            "city": "KODIAK",
            "state": "AK",
            "postal_code": "996156602",
            "telephone_number": "907-486-3281",
            "fax_number": "907-486-9546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES - WASHINGTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-12",
        "last_updated": "2025-05-13",
        "certification_date": "2025-05-13",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY OF ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AK",
            "license": "309115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Kodiak Island Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kodiak, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2025; 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.