Healthcare Provider Details

I. General information

NPI: 1851662233
Provider Name (Legal Business Name): GIRDWOOD HEALTH CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2012
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 LINDBLAD AVENUE
GIRDWOOD AK
99587
US

IV. Provider business mailing address

PO BOX 1130
GIRDWOOD AK
99587-1130
US

V. Phone/Fax

Practice location:
  • Phone: 907-783-1355
  • Fax: 907-783-1357
Mailing address:
  • Phone: 907-783-1355
  • Fax: 907-783-1357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: SUZANNE NIEMI
Title or Position: CFO
Credential:
Phone: 907-783-1355