| Southcentral Foundation | |
|
26341 Eklutna Village Rd Chugiak AK 99567-5148 | |
| (907) 688-6031 | |
| Not Available |
| Full Name | Southcentral Foundation |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 26341 Eklutna Village Rd, Chugiak, 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 26341 Eklutna Village Rd Chugiak AK 99567-5148 Ph: (907) 688-6031 |
| NPI Number | 1487121331 |
|---|---|
| Provider Enumeration Date | 10/30/2018 |
| Last Update Date | 10/10/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487121331 | NPI | - | NPPES |
| 1690189 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Secondary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |