Healthcare Provider Details

I. General information

NPI: 1750583464
Provider Name (Legal Business Name): CITY OF DELTA JUNCTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 12/02/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 DELTA AVENUE
DELTA JUNCTION AK
99737
US

IV. Provider business mailing address

PO BOX 229
DELTA JUNCTION AK
99737-0229
US

V. Phone/Fax

Practice location:
  • Phone: 907-895-4656
  • Fax: 907-895-4375
Mailing address:
  • Phone: 907-895-4656
  • Fax: 907-895-4375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0240
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierTR0276
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer

VIII. Authorized Official

Name: LORI M LATER-ROBERTS
Title or Position: CITY ADMINISTRATOR
Credential:
Phone: 907-895-4656