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General NPI Number Information
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NPI Number | 1205027505
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Entity Type | Organization
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Legal Business Name | BEAVER VILLAGE CLINIC
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 11/21/2018
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Provider Practice Location Address
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Address Line | 24030 MAIN STREET
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City | BEAVER
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State | AK
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Zip | 99724-0030
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Country | US
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Telephone | 907-628-6228
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Fax | 907-628-6228
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Provider Business Mailing Address
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Address Line | PO BOX 24030
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City | BEAVER
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State | AK
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Zip | 99724-0030
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Country | US
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Telephone | 907-628-6228
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Fax | 907-628-6228
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Authorized Official
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Title or Position | HEALTH DIRECTOR
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Name | MELINDA PETER
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Credential |
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Telephone | 907-662-7529
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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