1518088400 NPI number — NORTON SOUND HEALTH CORP

Table of content: (NPI 1518088400)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518088400 NPI number — NORTON SOUND HEALTH CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTON SOUND HEALTH CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518088400
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 966
Provider Second Line Business Mailing Address:
306 W 5TH
Provider Business Mailing Address City Name:
NOME
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99762-0966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-443-3311
Provider Business Mailing Address Fax Number:
907-443-6412

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SHAKTOOLIK CLINIC
Provider Second Line Business Practice Location Address:
MAIN ST BOX 09
Provider Business Practice Location Address City Name:
SHAKTOOLIK
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-443-3311
Provider Business Practice Location Address Fax Number:
907-443-6412
Provider Enumeration Date:
04/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GORN
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
Authorized Official Title or Position:
V P HOSPITAL SERVICES
Authorized Official Telephone Number:
907-443-3311

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X , with the licence number:  CL4689 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CL4689 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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