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Contact Information

SOUTHCENTRAL FOUNDATION
1001 S KNIK GOOSE BAY RD
WASILLA, AK99654-8083
 Phone: 907-631-7800
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Multi-Specialty

261QM1300X 70 Clinic or Group Practice
 

Primary Care

261QP2300X
Indicates primary specialty

NPI Profile & details for SOUTHCENTRAL FOUNDATION

NPI # 1386680056
LBN Legal business name SOUTHCENTRAL FOUNDATION
Authorized official RONALD OLSON - (EXECUTIVE VICE PRESIDENT FINANCE)
Entity Organization
Organization subpart 1 Yes
Enumeration date 06/21/2006
Last updated 09/01/2023 - About 3 years ago
Identifiers
AK License # 20467
AK Medicaid 1000873
AK Medicaid 1020925
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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