Healthcare Provider Details

I. General information

NPI: 1699923268
Provider Name (Legal Business Name): ASA'CARSARMIUT TRIBAL COUNCIL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2008
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OLD AIRPORT ROAD OFFICE #1
MOUNTAIN VILLAGE AK
99632-0249
US

IV. Provider business mailing address

PO BOX 32249
MOUNTAIN VILLAGE AK
99632-0249
US

V. Phone/Fax

Practice location:
  • Phone: 907-591-2814
  • Fax: 907-591-2811
Mailing address:
  • Phone: 907-591-2814
  • Fax: 907-591-2811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License NumberTRIBAL GOVERNMENT
License Number StateAK

VIII. Authorized Official

Name: MR. JAMES LANDLORD
Title or Position: 1ST CHIEF
Credential:
Phone: 907-591-2814