Healthcare Provider Details

I. General information

NPI: 1417031618
Provider Name (Legal Business Name): FIRST CITY MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 CARLANNA LAKE RD STE 201 BOX 6755
KETCHIKAN AK
99901-5642
US

IV. Provider business mailing address

212 CARLANNA LAKE RD STE 201 BOX 6755
KETCHIKAN AK
99901-5642
US

V. Phone/Fax

Practice location:
  • Phone: 907-247-3301
  • Fax: 907-247-3306
Mailing address:
  • Phone: 907-247-3301
  • Fax: 907-247-3306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number306825
License Number StateAK

VIII. Authorized Official

Name: STACY N SCHULZ
Title or Position: MANAGER
Credential: MD
Phone: 907-247-3301