Healthcare Provider Details

I. General information

NPI: 1588596746
Provider Name (Legal Business Name): RURAL ISLAND MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2.6 MILE ZIMOVIA HWY
WRANGELL AK
99929
US

IV. Provider business mailing address

PO BOX 1094
WRANGELL AK
99929-1094
US

V. Phone/Fax

Practice location:
  • Phone: 360-217-9392
  • Fax:
Mailing address:
  • Phone: 808-265-4482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VICTOR SANOE HARRISON
Title or Position: OWNER
Credential: MD
Phone: 360-217-9392