Southcentral Foundation | |
1000 Polovina Turnpike St Paul AK 99660 | |
(907) 546-2310 | |
Not Available |
Full Name | Southcentral Foundation |
---|---|
Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
Location | 1000 Polovina Turnpike, St Paul, Alaska |
Authorized Official Name and Position | Ronald L Olson (VP FINANCE) |
Authorized Official Contact | 9077294939 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Southcentral Foundation 4501 Diplomacy Dr Attn: Provider Enrollment Services Anchorage AK 99508-5919 Ph: () - | Southcentral Foundation 1000 Polovina Turnpike St Paul AK 99660 Ph: (907) 546-2310 |
NPI Number | 1831596311 |
---|---|
Provider Enumeration Date | 11/26/2014 |
Last Update Date | 11/26/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1831596311 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 20467 (Alaska) | Primary |