- Enrollment id
- O20060117001187
- Enrollment state
- AK
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1790844033
- Multiple npi flag
- N
- Ccn
- 027009
- Associate id
- 5395730626
- Organization name
- THE PETERSBURG MEDICAL CENTER
- Organization type structure
- OTHER
- Organization other type text
- MUNICIPALITY
- Proprietary nonprofit
- N
- Address line 1
- 103 FRAM ST
- City
- PETERSBURG
- State
- AK
- Zip code
- 998330589