Healthcare Provider Details

I. General information

NPI: 1134425564
Provider Name (Legal Business Name): QUTEKCAK NATIVE TRIBE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2011
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 THIRD AVE
SEWARD AK
99664-1467
US

IV. Provider business mailing address

PO BOX 1467
SEWARD AK
99664-1467
US

V. Phone/Fax

Practice location:
  • Phone: 907-224-3118
  • Fax: 907-224-5874
Mailing address:
  • Phone: 907-224-3118
  • Fax: 907-224-5874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateAK

VIII. Authorized Official

Name: MS. MARGARET M SIMONS
Title or Position: ELDERS PC
Credential: CC
Phone: 907-224-3118