Healthcare Provider Details

I. General information

NPI: 1558423392
Provider Name (Legal Business Name): EASTERN ALEUTIAN TRIBES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 BERING SEA RD.
AKUTAN AK
99553
US

IV. Provider business mailing address

3380 C ST SUITE 100
ANCHORAGE AK
99503-3920
US

V. Phone/Fax

Practice location:
  • Phone: 907-698-2208
  • Fax: 907-698-2280
Mailing address:
  • Phone: 907-277-1440
  • Fax: 907-277-1436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateAK

VIII. Authorized Official

Name: MS. JENNIFER HARRISON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 907-277-1440