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1 Flight Line Rd Port Alsworth AK 99653-9801 | |
(907) 781-2256 | |
Not Available |
Full Name | |
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Speciality | Clinic/center - Dental |
Location | 1 Flight Line Rd, Port Alsworth, Alaska |
Authorized Official Name and Position | Ronald Lee Olson (EXECUTIVE VICE PRESIDENT FINANCE) |
Authorized Official Contact | 9077294939 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 35151 Seattle WA 98124-5151 Ph: () - | 1 Flight Line Rd Port Alsworth AK 99653-9801 Ph: (907) 781-2256 |
NPI Number | 1114480167 |
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Provider Enumeration Date | 04/08/2019 |
Last Update Date | 08/31/2023 |
Identifier | Type | State | Issuer |
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1114480167 | NPI | - | NPPES |
1695503 | Medicaid | AK |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |