Healthcare Provider Details

I. General information

NPI: 1013079755
Provider Name (Legal Business Name): ALEUTIAN PRIBILOF ISLANDS ASSOCIATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 01/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

934 MAIN STREET
ST. GEORGE AK
99591
US

IV. Provider business mailing address

1131 E. INTERNATIONAL AIRPORT RD
ANCHORAGE AK
99518
US

V. Phone/Fax

Practice location:
  • Phone: 907-859-2254
  • Fax: 907-859-2252
Mailing address:
  • Phone: 907-276-2700
  • Fax: 907-279-4351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateAK
# 3
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DIMITRI PHILEMONOF
Title or Position: PRESIDENT/CEO
Credential:
Phone: 907-276-2700