| Southcentral Foundation | |
|
4030 Salmon Way Igiugig AK 99613 | |
| (907) 533-3207 | |
| Not Available |
| Full Name | Southcentral Foundation |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 4030 Salmon Way, Igiugig, Alaska |
| Authorized Official Name and Position | Ronald Lee Olson (EXECUTIVE VICE PRESIDENT FINANCE) |
| Authorized Official Contact | 9077294939 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southcentral Foundation Po Box 35151 Seattle WA 98124-5151 Ph: () - | Southcentral Foundation 4030 Salmon Way Igiugig AK 99613 Ph: (907) 533-3207 |
| NPI Number | 1841747748 |
|---|---|
| Provider Enumeration Date | 09/08/2016 |
| Last Update Date | 09/18/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841747748 | NPI | - | NPPES |
| 1654591 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 20467 (Alaska) | Primary |