1851601967 NPI number — ALASKA NATIVE TRIBAL HEALTH CONSORTIUM

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851601967 NPI number — ALASKA NATIVE TRIBAL HEALTH CONSORTIUM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALASKA NATIVE TRIBAL HEALTH CONSORTIUM
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:
1851601967
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4000 AMBASSADOR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99508-5909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-729-5600
Provider Business Mailing Address Fax Number:
907-729-5610

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
610 AKIACHUK DR.
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-543-0980
Provider Business Practice Location Address Fax Number:
907-543-0989
Provider Enumeration Date:
10/08/2010

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIARD
Authorized Official First Name:
MARY
Authorized Official Middle Name:
ELIZABETH
Authorized Official Title or Position:
CLINICAL SITE DIRECTOR
Authorized Official Telephone Number:
907-729-5602

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  6615 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 013929000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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