SOUTHCENTRAL FOUNDATION; NPI #1912954272

Contact Information

SOUTHCENTRAL FOUNDATION

101 AIRPORT ROAD
ILIAMNA, AK 99606

Phone: 907-571-1818
Fax:
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Multi-Specialty	261QM1300X	70	Clinic or Group Practice

Indicates primary specialty

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NPI Profile & details for SOUTHCENTRAL FOUNDATION

NPI # 1912954272

LBN Legal business name SOUTHCENTRAL FOUNDATION

Authorized official RONALD OLSON - (EXECUTIVE VICE PRESIDENT FINANCE)

Entity Organization

Organization subpart ¹ Yes

Enumeration date 05/30/2006

Last updated 09/18/2023 - About 3 years ago

Identifiers

AK	License #	20467
AK	Medicaid	1000810

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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