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General NPI Number Information
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NPI Number | 1699983361
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Entity Type | Organization
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Legal Business Name | KETCHIKAN INDIAN CORPORATION
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 03/07/2023
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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 | 907-225-0320
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Fax | 907-247-4819
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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 | 907-225-0320
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Fax | 907-247-4819
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Authorized Official
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Title or Position | RCM
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Name | WENDY ROSS
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Credential |
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Telephone | 907-228-9254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332800000X
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Taxonomy Name | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
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License Number |
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License Number State |
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