Full Name | |
---|---|
Speciality | Family Medicine |
Location | 10 Dnr Road, Mcgrath, Alaska |
Authorized Official Name and Position | Ronald Lee Olson (VP 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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4501 Diplomacy Dr Attn: Provider Enrollment Anchorage AK 99508-5919 Ph: (907) 729-4955 | 10 Dnr Road Mcgrath AK 99627 Ph: (907) 524-3299 |
NPI Number | 1366615114 |
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Provider Enumeration Date | 04/11/2008 |
Last Update Date | 02/04/2016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1366615114 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 20467 (Alaska) | Primary |