| Southcentral Foundation | |
|
101 Airport Road Iliamna AK 99606 | |
| (907) 571-1818 | |
| Not Available |
| Full Name | Southcentral Foundation |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 101 Airport Road, Iliamna, 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 101 Airport Road Iliamna AK 99606 Ph: (907) 571-1818 |
| NPI Number | 1396292298 |
|---|---|
| Provider Enumeration Date | 09/08/2016 |
| Last Update Date | 09/05/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396292298 | NPI | - | NPPES |
| 1654555 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 20467 (Alaska) | Primary |
Southcentral Foundation Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 101 Airport Road, Iliamna, AK 99606 Phone: 907-571-1818 |