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Contact Information

SOUTHCENTRAL FOUNDATION
2516 MOUNTAIN CIRCLE
PEDRO BAY, AK99647
 Phone: 907-850-2229
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

General Practice

1223G0001X
Indicates primary specialty

NPI Profile & details for SOUTHCENTRAL FOUNDATION

NPI Number 1144777046
LBN Legal business name SOUTHCENTRAL FOUNDATION
Authorized official RONALD OLSON - (EXECUTIVE VICE PRESIDENT FINANCE)
Entity Organization
Organization subpart 1 Yes
Enumeration date 09/08/2016
Last updated 09/01/2023 - About 3 years ago
Identifiers
AK License # 20467
AK Medicaid 1654571
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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