| Southcentral Foundation | |
|
102 Fireweed Lane Newhalen AK 99606 | |
| (907) 571-1231 | |
| (907) 571-1551 |
| Full Name | Southcentral Foundation |
|---|---|
| Speciality | Clinic/center - Community Health |
| Location | 102 Fireweed Lane, Newhalen, Alaska |
| Authorized Official Name and Position | Ronald Lee 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: Finance/provider Enrollment Anchorage AK 99508-5919 Ph: (907) 729-4955 | Southcentral Foundation 102 Fireweed Lane Newhalen AK 99606 Ph: (907) 571-1231 |
| NPI Number | 1295104644 |
|---|---|
| Provider Enumeration Date | 09/16/2015 |
| Last Update Date | 09/16/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295104644 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | 20467 (Alaska) | Primary |