Healthcare Provider Details

I. General information

NPI: 1114026069
Provider Name (Legal Business Name): FAMILY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 SERVICE ST
DELTA JUNCTION AK
99737
US

IV. Provider business mailing address

HC 60 BOX 4860
DELTA JUNCTION AK
99737-9440
US

V. Phone/Fax

Practice location:
  • Phone: 907-895-5100
  • Fax: 907-895-5133
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberAA2011
License Number StateAK

VIII. Authorized Official

Name: RAY ANDERSON
Title or Position: PHYSICIAN OWNER
Credential:
Phone: 907-895-5100