| Southcentral Foundation | |
|
2516 Mountain Circle Pedro Bay AK 99647 | |
| (907) 850-2229 | |
| Not Available |
| Full Name | Southcentral Foundation |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2516 Mountain Circle, Pedro Bay, 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 35198 Seattle WA 98124-5198 Ph: () - | Southcentral Foundation 2516 Mountain Circle Pedro Bay AK 99647 Ph: (907) 850-2229 |
| NPI Number | 1780287920 |
|---|---|
| Provider Enumeration Date | 11/19/2020 |
| Last Update Date | 09/15/2023 |
| Certification Date | 09/15/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780287920 | NPI | - | NPPES |
| 1716559 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |