MEDICARE: FIRST CITY MEDICINE LLC

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	261QP2300X	Primary Care Clinic/Center	306825	AK

General Provider Information

NPI Number	:	1417031618
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST CITY MEDICINE LLC

Provider Business Mailing Address
First Line	:	212 CARLANNA LAKE RD STE 201
Second Line	:	BOX 6755
City	:	KETCHIKAN
State	:	AK
Zip	:	99901-5642
Country	:	US
Telephone Number	:	907-247-3301
Fax Number	:	907-247-3306

Provider Business Practice Location Address
First Line	:	212 CARLANNA LAKE RD STE 201
Second Line	:	BOX 6755
City	:	KETCHIKAN
State	:	AK
Zip	:	99901-5642
Country	:	US
Telephone Number	:	907-247-3301
Fax Number	:	907-247-3306

Authorized Official
Title or Position	:	MANAGER
Name	:	STACY N SCHULZ
Credential	:	MD
Telephone Number	:	907-247-3301

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	08/22/2020

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Directions to “FIRST CITY MEDICINE LLC ” Practice Location

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