| Bh 1115- Iguigig | |
|
4030 Salmon Way Iguigig AK 99613 | |
| (907) 533-3207 | |
| Not Available |
| Full Name | Bh 1115- Iguigig |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4030 Salmon Way, Iguigig, 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 |
|---|---|
| Bh 1115- Iguigig Po Box 35198 Seattle WA 98124-5198 Ph: () - | Bh 1115- Iguigig 4030 Salmon Way Iguigig AK 99613 Ph: (907) 533-3207 |
| NPI Number | 1093318248 |
|---|---|
| Provider Enumeration Date | 11/19/2020 |
| Last Update Date | 08/31/2023 |
| Certification Date | 08/30/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093318248 | NPI | - | NPPES |
| 1714242 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |