Healthcare Provider Details

I. General information

NPI: 1457735003
Provider Name (Legal Business Name): ALASKA NATIVE TRIBAL HEALTH CONSORTIUM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 07/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3449 REZANOF DR E
KODIAK AK
99615-6952
US

IV. Provider business mailing address

4000 AMBASSADOR DR
ANCHORAGE AK
99508-5909
US

V. Phone/Fax

Practice location:
  • Phone: 907-729-2460
  • Fax: 907-729-2362
Mailing address:
  • Phone: 907-729-2460
  • Fax: 907-729-2362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROALD HELGESEN
Title or Position: CEO
Credential:
Phone: 907-729-1900