| Bethel Family Clinic | |
|
631 Main Street Bethel AK 99559-1908 | |
| (907) 543-3773 | |
| (907) 543-3545 |
| Full Name | Bethel Family Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 631 Main Street, Bethel, Alaska |
| Authorized Official Name and Position | Suzanne Niemi (FINANCE) |
| Authorized Official Contact | 9075439852 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bethel Family Clinic Po Box 1908 631 Main Street Bethel AK 99559-1908 Ph: (907) 543-3773 | Bethel Family Clinic 631 Main Street Bethel AK 99559-1908 Ph: (907) 543-3773 |
| NPI Number | 1124078019 |
|---|---|
| Provider Enumeration Date | 05/11/2006 |
| Last Update Date | 11/27/2018 |
| Medicare PECOS PAC ID | 7719876416 |
|---|---|
| Medicare Enrollment ID | O20040311000904 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124078019 | NPI | - | NPPES |
| 1029936 | Medicaid | AK | |
| 02-1835 | Other | AK | MEDICARE PART A PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Allen F Freudenthal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225220718 PECOS PAC ID: 3779678891 Enrollment ID: I20071004000631 |
| Provider Name | Debra L Cyphert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982601498 PECOS PAC ID: 9739141946 Enrollment ID: I20161026000600 |
| Provider Name | Melissa N Cockrell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093037731 PECOS PAC ID: 9830378306 Enrollment ID: I20200702002127 |
| Provider Name | Jonvanni M Bongolan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124335807 PECOS PAC ID: 3173795408 Enrollment ID: I20220711002547 |
| Provider Name | Richard D Robb |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1649492216 PECOS PAC ID: 7214479914 Enrollment ID: I20240610002590 |
Yukon Kuskokwim Health Corporation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 833 State Highway, Bethel, AK 99559 Phone: 907-543-6452 Fax: 907-543-6117 | |
Bethel Family Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 660 3rd Avenue, Bethel, AK 99559 Phone: 907-545-3996 | |
Yukon Kuskokwim Health Corporation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 835 State Highway, Bethel, AK 99559 Phone: 907-543-6452 Fax: 907-543-6117 | |
Yukon Kuskokwim Health Corporation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1360 Calista Drive, Bethel, AK 99559 Phone: 907-543-6452 | |
Bethel Family Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 430 Main Street, Bethel, AK 99559 Phone: 907-543-3773 | |
Yukon Kuskokwim Health Corporation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 700 Chief Eddie Hoffman Hwy, Bethel, AK 99559 Phone: 907-543-6452 Fax: 907-543-6117 |