| Southcentral Foundation | |
| 
					9105 Airport Drive Nikolai AK 99691  | |
| (907) 293-2328 | |
| Not Available | 
| Full Name | Southcentral Foundation | 
|---|---|
| Speciality | Dentist - General Practice | 
| Location | 9105 Airport Drive, Nikolai, Alaska | 
| Authorized Official Name and Position | Ronald Lee Olsen (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 9105 Airport Drive Nikolai AK 99691 Ph: (907) 293-2328  | 
| NPI Number | 1124575022 | 
|---|---|
| Provider Enumeration Date | 09/08/2016 | 
| Last Update Date | 09/01/2023 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1124575022 | NPI | - | NPPES | 
| 1654551 | Medicaid | AK | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 20467 (Alaska) | Primary |