Healthcare Provider Details

I. General information

NPI: 1689719825
Provider Name (Legal Business Name): YUKON-KUSKOKWIM HEALTH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 04/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHIEF EDDIE HOFFMAN HWY
BETHEL AK
99559-0827
US

IV. Provider business mailing address

PO BOX 287
BETHEL AK
99559-0287
US

V. Phone/Fax

Practice location:
  • Phone: 907-543-6000
  • Fax: 907-543-6306
Mailing address:
  • Phone: 907-543-6000
  • Fax: 907-543-6306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DAN WINKELMAN
Title or Position: CEO
Credential:
Phone: 907-543-6000