Full Name | |
---|---|
Speciality | Clinic/center - Community 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 |
---|---|
Po Box 35198 Seattle WA 98124-5198 Ph: () - | 4030 Salmon Way Iguigig AK 99613 Ph: (907) 533-3207 |
NPI Number | 1144699216 |
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Provider Enumeration Date | 09/18/2015 |
Last Update Date | 08/31/2023 |
Identifier | Type | State | Issuer |
---|---|---|---|
1144699216 | NPI | - | NPPES |
1637735 | Medicaid | AK |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QC1500X | Clinic/center - Community Health | 20467 (Alaska) | Primary |