INTEGRATED SUPPORT COMMAND KODIAK; NPI #1720064884

Contact Information

INTEGRATED SUPPORT COMMAND KODIAK

BUILDING N46 CAPE SARICHEF
KODIAK, AK 99619-5002

Phone: 907-487-5757
Fax: 907-487-5360
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Clinic/Center	261Q00000X
Dental	261QD0000X
Military Clinical Medical Laboratory	291900000X	B4[14]	Histocompatibility Laboratory
Military/U.S. Coast Guard Pharmacy	332000000X	87	All Other Suppliers

Indicates primary specialty

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NPI Profile & details for INTEGRATED SUPPORT COMMAND KODIAK

NPI Number 1720064884

LBN Legal business name INTEGRATED SUPPORT COMMAND KODIAK

Authorized official TODD EMERSON - (CLINIC ADMINISTRATOR)

Entity Organization

Organization subpart ¹ Yes

Enumeration date 12/21/2005

Last updated 07/28/2008 - About 18 years ago

Identifiers

AK	License #	02D0666660
AK	License #	NCPDP0202414

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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