Healthcare Provider Details

I. General information

NPI: 1942368428
Provider Name (Legal Business Name): YUKON KUSKOKWIM HEALTH CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 BUSINESS PARK BLVD E25
ANCHORAGE AK
99503-7124
US

IV. Provider business mailing address

4700 BUSINESS PARK BLVD E25
ANCHORAGE AK
99503-7124
US

V. Phone/Fax

Practice location:
  • Phone: 907-677-7501
  • Fax: 907-677-7502
Mailing address:
  • Phone: 907-677-7501
  • Fax: 907-677-7502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: MR. GENE PELTOLA
Title or Position: CEO
Credential:
Phone: 907-543-6020