Healthcare Provider Details

I. General information

NPI: 1871704395
Provider Name (Legal Business Name): COUNCIL OF ATHABASCAN TRIBAL GOVERNMENTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SPRUCE STREET
FORT YUKON AK
99740
US

IV. Provider business mailing address

PO BOX 309
FORT YUKON AK
99740
US

V. Phone/Fax

Practice location:
  • Phone: 907-662-2460
  • Fax: 907-662-2709
Mailing address:
  • Phone: 907-662-2460
  • Fax: 907-662-2709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TAMARA KAY THOMAS
Title or Position: EHR BILLING COORDINATOR
Credential:
Phone: 907-662-2460