MEDICARE: EMK INNOVATIVE HEALTH CARE CLINIC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QM0850X	Adult Mental Health Clinic/Center
3	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1376368829
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMK INNOVATIVE HEALTH CARE CLINIC

Provider Business Mailing Address
First Line	:	PO BOX 140665
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99514-0665
Country	:	US
Telephone Number	:	907-317-1703
Fax Number	:

Provider Business Practice Location Address
First Line	:	204 MULDOON RD
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99504-1502
Country	:	US
Telephone Number	:	907-317-1703
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	DR. HENRIETTA EMOKIDI
Credential	:	DNP, APRN
Telephone Number	:	907-317-1703

Provider Enumeration Date	:	11/20/2024
Last Update Date	:	11/20/2024

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Directions to “EMK INNOVATIVE HEALTH CARE CLINIC ” Practice Location

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