| Eastern Aleutian Tribes, Inc | |
|
2105 Main Street Adak AK 99546 | |
| (907) 592-8383 | |
| (907) 592-4287 |
| Full Name | Eastern Aleutian Tribes, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2105 Main Street, Adak, Alaska |
| Authorized Official Name and Position | Jennifer Harrison (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9072771440 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eastern Aleutian Tribes, Inc 3380 C St Suite 100 Anchorage AK 99503-3920 Ph: (907) 277-1440 | Eastern Aleutian Tribes, Inc 2105 Main Street Adak AK 99546 Ph: (907) 592-8383 |
| NPI Number | 1285796094 |
|---|---|
| Provider Enumeration Date | 12/15/2006 |
| Last Update Date | 04/13/2015 |
| Medicare PECOS PAC ID | 2860301884 |
|---|---|
| Medicare Enrollment ID | O20040331000995 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285796094 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | (Alaska) | Primary |
| Provider Name | Danita N Koehler |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750455150 PECOS PAC ID: 9638193659 Enrollment ID: I20060118000033 |
| Provider Name | Thai G Verzone |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1679534721 PECOS PAC ID: 4183645203 Enrollment ID: I20060210000547 |
| Provider Name | Ruth S Alvarez |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1194815126 PECOS PAC ID: 6204931801 Enrollment ID: I20070410000229 |
| Provider Name | Carol J Borg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356394282 PECOS PAC ID: 1557364486 Enrollment ID: I20081006000044 |
| Provider Name | Katherine G Van Atta |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1740358167 PECOS PAC ID: 2264587732 Enrollment ID: I20090904000316 |
| Provider Name | Keils K Kitchen |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1033350442 PECOS PAC ID: 8628120227 Enrollment ID: I20091124000394 |
| Provider Name | Cameron a Karlsen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316245509 PECOS PAC ID: 6305022518 Enrollment ID: I20110523000591 |
| Provider Name | Lesley K De Jaray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700171030 PECOS PAC ID: 5395916167 Enrollment ID: I20110927000907 |
| Provider Name | Olegario X Carrillo |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1417946039 PECOS PAC ID: 8527057066 Enrollment ID: I20140916001095 |
| Provider Name | Olivia JW Petrie |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1124416334 PECOS PAC ID: 8921325424 Enrollment ID: I20150321000002 |
| Provider Name | Terri L Douglas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396018818 PECOS PAC ID: 7416110952 Enrollment ID: I20150416002162 |
| Provider Name | Beatriz Dietrick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578972170 PECOS PAC ID: 1951613389 Enrollment ID: I20150629000096 |
| Provider Name | Troy D Wiles |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1285610717 PECOS PAC ID: 4486691854 Enrollment ID: I20161006000919 |
| Provider Name | Linda L Dupree |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1073516167 PECOS PAC ID: 8022015619 Enrollment ID: I20161012002688 |
| Provider Name | Kimberly Ann Saunders |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174841605 PECOS PAC ID: 8022247345 Enrollment ID: I20161031001925 |
| Provider Name | Mary I Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508823584 PECOS PAC ID: 6103833355 Enrollment ID: I20161114000486 |
| Provider Name | Daniel J Hartman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114130903 PECOS PAC ID: 2860534922 Enrollment ID: I20161215000521 |
| Provider Name | Melodie K Isgro |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1528094968 PECOS PAC ID: 9830166933 Enrollment ID: I20170106001174 |
| Provider Name | Jeremy J Loving |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1346505732 PECOS PAC ID: 0244482313 Enrollment ID: I20170203000777 |