Healthcare Provider Details

I. General information

NPI: 1811106271
Provider Name (Legal Business Name): ALASKA NATIVE TRIBAL HEALTH CONSORTIUM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 05/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 DIPLOMACY DR
ANCHORAGE AK
99508-5926
US

IV. Provider business mailing address

4315 DIPLOMACY DR
ANCHORAGE AK
99508-5926
US

V. Phone/Fax

Practice location:
  • Phone: 907-729-3971
  • Fax: 907-729-1542
Mailing address:
  • Phone: 907-729-3971
  • Fax: 907-729-1542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number255468
License Number StateAK

VIII. Authorized Official

Name: PAUL SHERRY
Title or Position: CEO
Credential:
Phone: 907-729-1905