MEDICARE: NORTHWAY FAMILY HEALTHCARE

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
1	261Q00000X	Clinic/Center

Other Identifiers

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

General Provider Information

NPI Number	:	1386398881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWAY FAMILY HEALTHCARE

Provider Business Mailing Address
First Line	:	130 CARLANNA LAKE RD STE 201
Second Line	:
City	:	KETCHIKAN
State	:	AK
Zip	:	99901-5669
Country	:	US
Telephone Number	:	907-225-4325
Fax Number	:	907-225-4326

Provider Business Practice Location Address
First Line	:	130 CARLANNA LAKE RD STE 201
Second Line	:
City	:	KETCHIKAN
State	:	AK
Zip	:	99901-5669
Country	:	US
Telephone Number	:	907-225-4325
Fax Number	:	907-225-4326

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MAUREEN MAKA NORTHWAY
Credential	:	DNP
Telephone Number	:	907-225-4325

Provider Enumeration Date	:	02/04/2022
Last Update Date	:	02/04/2022

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Directions to “NORTHWAY FAMILY HEALTHCARE ” Practice Location

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