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General NPI Number Information
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NPI Number | 1437471844
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Entity Type | Organization
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Legal Business Name | KIC TRIBAL HEALTH CLINIC
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Dates
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Enumeration Date | 02/26/2010
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Last Update Date | 02/26/2010
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Provider Practice Location Address
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Address Line | 2960 TONGASS AVE
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City | KETCHIKAN
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State | AK
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Zip | 99901-5742
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Country | US
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Telephone | 907-228-4900
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Fax |
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Provider Business Mailing Address
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Address Line | 2960 TONGASS AVE
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City | KETCHIKAN
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State | AK
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Zip | 99901-5742
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | DEBBIE PATTON
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Credential |
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Telephone | 907-228-4900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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