Healthcare Provider Details

I. General information

NPI: 1114306529
Provider Name (Legal Business Name): NORTON SOUND HEALTH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2015
Last Update Date: 05/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 GREG KRUSHECK AVE
NOME AK
99762-0966
US

IV. Provider business mailing address

1000 GREG KRUSHECK AVE
NOME AK
99762-0966
US

V. Phone/Fax

Practice location:
  • Phone: 907-443-3311
  • Fax: 907-443-3723
Mailing address:
  • Phone: 907-443-3311
  • Fax: 907-443-3723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberAU0076
License Number StateAK

VIII. Authorized Official

Name: ANGELA F GORN
Title or Position: CEO
Credential:
Phone: 907-443-3286