| State Of Alaska | |
|
3054 Fifth Ave Ketchikan AK 99901-5773 | |
| (907) 225-4350 | |
| (907) 247-0978 |
| Full Name | State Of Alaska |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 3054 Fifth Ave, Ketchikan, Alaska |
| Authorized Official Name and Position | Susan Renee Bergmann (NURSE MANAGER) |
| Authorized Official Contact | 9072254350 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| State Of Alaska 14818 N Tongass Hwy Ketchikan AK 99901-8902 Ph: (907) 225-4328 | State Of Alaska 3054 Fifth Ave Ketchikan AK 99901-5773 Ph: (907) 225-4350 |
| NPI Number | 1346601457 |
|---|---|
| Provider Enumeration Date | 03/16/2016 |
| Last Update Date | 03/16/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346601457 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | NURR8365 (Alaska) | Primary |
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