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NPI Code Detail

MEDICARE: SOUTHCENTRAL FOUNDATION

MEDICARE: SOUTHCENTRAL FOUNDATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM1300XMulti-Specialty Clinic/Center
2261QP2300XPrimary Care Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184678559
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHCENTRAL FOUNDATION
Provider Business Mailing Address
First Line : PO BOX 35198
Second Line :
City : SEATTLE
State : WA
Zip : 98124-5198
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4130 SAN ERNESTO AVE
Second Line :
City : ANCHORAGE
State : AK
Zip : 99508-2875
Country : US
Telephone Number : 907-729-5070
Fax Number :
Authorized Official
Title or Position : EXECUTIVE VICE PRESIDENT FINANCE
Name : RONALD LEE OLSON
Credential :
Telephone Number : 907-729-4939
Provider Enumeration Date : 05/20/2006
Last Update Date : 04/19/2024

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Directions to “SOUTHCENTRAL FOUNDATION ” Practice Location

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