| Kimmie C Smith | |
|
817 Zimovia Highway Apt 3 Wrangell AK 99929 | |
| (907) 305-0985 | |
| Not Available |
| Full Name | Kimmie C Smith |
|---|---|
| Speciality | Clinic/Center |
| Location | 817 Zimovia Highway, Wrangell, Alaska |
| Authorized Official Name and Position | Kimmie C Smith (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 9073050985 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kimmie C Smith Po Box 644 Wrangell AK 99929-0644 Ph: (907) 305-0985 | Kimmie C Smith 817 Zimovia Highway Apt 3 Wrangell AK 99929 Ph: (907) 305-0985 |
| NPI Number | 1255069084 |
|---|---|
| Provider Enumeration Date | 08/10/2022 |
| Last Update Date | 01/25/2024 |
| Certification Date | 01/25/2024 |
| Medicare PECOS PAC ID | 3678916749 |
|---|---|
| Medicare Enrollment ID | O20240206000465 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255069084 | NPI | - | NPPES |
| 1717330 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Kimmie Smith |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1649578204 PECOS PAC ID: 4587007653 Enrollment ID: I20240206000580 |
Southeast Alaska Regional Health Consortium Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 110 Lynch Street, Wrangell, AK 99929 Phone: 907-874-3375 | |
Southeast Alaska Regional Health Consortium Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 333 Church Street, Wrangell, AK 99929 Phone: 907-874-2373 Fax: 907-874-2576 | |
Southeast Alaska Regional Health Consortium Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 110 Lynch Street, Wrangell, AK 99929 Phone: 907-874-3375 Fax: 907-874-3339 | |
Alaska Island Community Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 333 Church Street, Wrangell, AK 99929 Phone: 907-874-2373 Fax: 907-874-2576 |