CORDOVA COMMUNITY MEDICAL CENTER (CORDOVA COMMUNITY MEDICAL CENTER) NPI 1215035787

General Acute Care Hospital (Critical Access) in Cordova, AK

NPI 1215035787 Organization General Acute Care Hospital Critical Access CLIA Number 02D0641826 CLIA Certificate of Compliance

About CORDOVA COMMUNITY MEDICAL CENTER (CORDOVA COMMUNITY MEDICAL CENTER)

Cordova Community Medical Center (cordova Community Medical Center) is a provider established in Cordova, Alaska specializing in general acute care hospital (critical access) . The NPI number of Cordova Community Medical Center (cordova Community Medical Center) is 1215035787 and was assigned on September 2006. The practitioner's primary taxonomy code is 282NC0060X. The provider is registered as an organization and their NPI record was last updated one year ago. The provider's is doing business as Cordova Community Medical Center. The authorized official of this NPI record is Eric James Price (Chief Financial Officer)

The CLIA number of Cordova Community Medical Center is 02D0641826 registered as a "hospital" facility with a CLIA Certificate of Compliance. This CLIA certificate is issued to Cordova Community Medical Center after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements. This type of certificate is issued to laboratories that perform nonwaived (moderate and/or high complexity) testing.

NPI

1215035787

Provider NameCORDOVA COMMUNITY MEDICAL CENTER (CORDOVA COMMUNITY MEDICAL CENTER)
Provider Location Address602 CHASE AVE CORDOVA, AK 99574
Provider Mailing AddressPO BOX 160 602 CHASE AVE CORDOVA, AK 99574
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Other Organization NameCORDOVA COMMUNITY MEDICAL CENTER
Other Name TypeDoing Business As (3)
Enumeration Date09-20-2006
Last Update Date06-02-2021


Primary Taxonomy

Taxonomy Code282NC0060X
ClassificationGeneral Acute Care Hospital
TypeHospitals
SpecializationCritical Access
License StateAK
Taxonomy DescriptionDefinition to come.

Business Address

CORDOVA COMMUNITY MEDICAL CENTER
602 CHASE AVE
CORDOVA, AK
ZIP 99574
Phone: (907) 424-8000
Fax: (907) 424-8116

Get Directions


Mailing Address

CORDOVA COMMUNITY MEDICAL CENTER
PO BOX 160
602 CHASE AVE
CORDOVA, AK
ZIP 99574
Phone: (907) 424-8000
Fax: (907) 424-8116



Authorized Official

Authorized Official Name ERIC JAMES PRICE
Authorized Official TitleCHIEF FINANCIAL OFFICER
Authorized Official Phone(907) 424-8228

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1215035787 is:

CLIA Number02D0641826
Facility TypeHOSPITAL
Certificate TypeCertificate of Compliance

Secondary Taxonomies


The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.

No. Taxonomy Code Type Classification Specialization License No. State Primary
1313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care FacilityAKNo

Taxonomy Description: 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.

2314000000XNursing & Custodial Care FacilitiesSkilled Nursing FacilityAKNo

Taxonomy Description: (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.

33416L0300XTransportation ServicesAmbulanceLand TransportNo

Taxonomy Description: Not Available

4385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental DisabilitiesNo

Taxonomy Description: a facility or distinct part of a facility that provides short term, residential care to children, diagnosed with intellectual and/or developmental disabilities as respite for the regular caregivers.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
CMG287MEDICAID (05)AK
CM6143MEDICAID (05)AK
HS07IPMEDICAID (05)AK
HC2871MEDICAID (05)AK
0200927OTHER (01)AK
CM9745MEDICAID (05)AK
MH6324MEDICAID (05)AK
DA4455MEDICAID (05)AK
HS07LTMEDICAID (05)AK
HS07OPMEDICAID (05)AK
HS07SBMEDICAID (05)AK

Other Providers at the same location


The following 7 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1225062920DR. ALYCE L GARRITY MD
Individual
Emergency Medicine602 CHASE AVE
CORDOVA, AK 99574
(907) 424-8000
1609907393DR. STEPHEN MARK SUNDBY PH.D., LPC, CDC I
Individual
Counselor602 CHASE AVE
CORDOVA, AK 99574
(907) 424-8300
1700045499 STEPHENIE JAMES SAUNDERS
Individual
Counselor (Professional)602 CHASE AVE
CORDOVA, AK 99574
(907) 424-8300
1013077080CORDOVA COMMUNITY HOSPITAL
Organization
Pharmacy (Long Term Care Pharmacy)602 CHASE AVE
CORDOVA, AK 99574
(907) 424-8000
1861809238 HEIDI VOSS PHARMD
Individual
Pharmacist602 CHASE AVE
CORDOVA, AK 99574
(907) 424-8254
1225266588CORDOVA COMMUNITY MEDICAL CENTER
Organization
Family Medicine602 CHASE AVE
CORDOVA, AK 99574
(907) 424-8000
1609395128CORDOVA COMMUNITY MEDICAL CENTER
Organization
Pharmacy (Community/Retail Pharmacy)602 CHASE AVE
CORDOVA, AK 99574
(907) 424-8017

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.