Healthcare Provider Details

I. General information

NPI: 1225228729
Provider Name (Legal Business Name): BIRCH CREEK CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 11/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KBC 100
FORT YUKON AK
99740-0040
US

IV. Provider business mailing address

KBC 100
FORT YUKON AK
99740-0040
US

V. Phone/Fax

Practice location:
  • Phone: 907-221-2537
  • Fax: 907-221-2536
Mailing address:
  • Phone: 907-221-2537
  • Fax: 907-221-2536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELINDA PETER
Title or Position: HEALTH DIRECTOR
Credential:
Phone: 907-662-7529