Healthcare Provider Details

I. General information

NPI: 1154452878
Provider Name (Legal Business Name): SITKA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 08/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 KATLIAN ST STE E
SITKA AK
99835-7359
US

IV. Provider business mailing address

700 KATLIAN ST SUITE E
SITKA AK
99835-7359
US

V. Phone/Fax

Practice location:
  • Phone: 907-747-5861
  • Fax: 907-747-5415
Mailing address:
  • Phone: 907-747-5861
  • Fax: 907-747-5415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number483
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number118937
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number118937
License Number StateAK

VIII. Authorized Official

Name: ROBERT C HUNTER
Title or Position: MEDICAL DOCTOR
Credential: M.D
Phone: 907-747-5861