| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 115 Airport Rd, Yakutat, Alaska |
| Authorized Official Name and Position | Cathy Wassillie (FINANCE MANAGER) |
| Authorized Official Contact | 9077843275 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 112 Yakutat AK 99689-0112 Ph: (907) 784-3275 | 115 Airport Rd Yakutat AK 99689 Ph: (907) 784-3275 |
| NPI Number | 1871529628 |
|---|---|
| Provider Enumeration Date | 06/23/2006 |
| Last Update Date | 06/30/2021 |
| Medicare PECOS PAC ID | 4981968369 |
|---|---|
| Medicare Enrollment ID | O20180511000635 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871529628 | NPI | - | NPPES |
| MEDICAID | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 288254 (Alaska) | Primary |
| 363A00000X | Physician Assistant | (* (Not Available)) | Secondary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
| Provider Name | Sul Ross O Thorward |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013003938 PECOS PAC ID: 2961530415 Enrollment ID: I20100504000841 |
| Provider Name | Mark G Schultz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235438433 PECOS PAC ID: 2264610955 Enrollment ID: I20110628000715 |
| Provider Name | Debra Waddell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134366156 PECOS PAC ID: 0143545640 Enrollment ID: I20150910002216 |
| Provider Name | Molly Rothmeyer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639238652 PECOS PAC ID: 0547458309 Enrollment ID: I20160421000227 |
| Provider Name | Debra S Scheel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568468189 PECOS PAC ID: 5496778391 Enrollment ID: I20161202000087 |
| Provider Name | Mary A Verardi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1407039415 PECOS PAC ID: 0840375861 Enrollment ID: I20171023002771 |
| Provider Name | Dawn Hardwick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023481793 PECOS PAC ID: 0143510446 Enrollment ID: I20171205000459 |
| Provider Name | Nancy E Brew |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366690315 PECOS PAC ID: 8426031667 Enrollment ID: I20180521000562 |
| Provider Name | Richard Fitzgerald Mccoy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902314511 PECOS PAC ID: 9931468725 Enrollment ID: I20190417000351 |
| Provider Name | Tracey L Carter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306247796 PECOS PAC ID: 4284926254 Enrollment ID: I20200128000038 |
| Provider Name | Aric Ludwig |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1144397464 PECOS PAC ID: 7719901479 Enrollment ID: I20200508001862 |
| Provider Name | Deanna J Mehlhoff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306473103 PECOS PAC ID: 1759712664 Enrollment ID: I20200508002413 |
| Provider Name | Edward J Prince |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1659306975 PECOS PAC ID: 5193755163 Enrollment ID: I20210621000436 |
| Provider Name | David M Prince |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1487661534 PECOS PAC ID: 9931500139 Enrollment ID: I20210625000241 |
| Provider Name | Victoria Brueggert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992231260 PECOS PAC ID: 1456628924 Enrollment ID: I20210921002945 |
| Provider Name | Bradley Mcconnell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1437381720 PECOS PAC ID: 6406164383 Enrollment ID: I20220112001966 |
| Provider Name | Courtney Mcconnell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1740691997 PECOS PAC ID: 0840624888 Enrollment ID: I20220531000086 |
| Provider Name | Paul Andrew Young |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1922532472 PECOS PAC ID: 1456623859 Enrollment ID: I20220712001499 |
| Provider Name | Michelle J Hinton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346717428 PECOS PAC ID: 2466794961 Enrollment ID: I20220815001545 |
| Provider Name | Justin M Dowd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316563927 PECOS PAC ID: 2264855840 Enrollment ID: I20230317000414 |
| Provider Name | Joseph Borshanian |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417917501 PECOS PAC ID: 3779480652 Enrollment ID: I20230601001510 |
| Provider Name | Phillip R Hurd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194054312 PECOS PAC ID: 1759423312 Enrollment ID: I20240521001389 |
Yakutat Community Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 112 Airport Road, Yakutat, AK 99689 Phone: 907-784-3275 Fax: 907-784-3286 |