Healthcare Provider Details

I. General information

NPI: 1548293798
Provider Name (Legal Business Name): SOUTHCENTRAL FOUNDATION NIKOLAI HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9105 AIRPORT DRIVE
NIKOLAI AK
99691
US

IV. Provider business mailing address

4201 TUDOR CENTRE DR STE 320
ANCHORAGE AK
99508-5916
US

V. Phone/Fax

Practice location:
  • Phone: 907-293-2328
  • Fax: 907-729-6353
Mailing address:
  • Phone: 907-729-4955
  • Fax: 907-729-6353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateAK

VIII. Authorized Official

Name: CATHY A LEMAY
Title or Position: DIRECTOR OF PATIENT ACCOUNTS
Credential:
Phone: 907-729-4955