| Searhc Aics Coffman Cove | |
|
105 Nw Kodiak Dr Coffman Cove AK 99918 | |
| (907) 874-4700 | |
| (907) 874-4719 |
| Full Name | Searhc Aics Coffman Cove |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 105 Nw Kodiak Dr, Coffman Cove, Alaska |
| Authorized Official Name and Position | Daniel Harris (VP/CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 9074634000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Searhc Aics Coffman Cove 3100 Channel Drive Ste 300 Attn: Provider Enrollment Juneau AK 99801 Ph: (907) 463-4000 | Searhc Aics Coffman Cove 105 Nw Kodiak Dr Coffman Cove AK 99918 Ph: (907) 874-4700 |
| NPI Number | 1932645512 |
|---|---|
| Provider Enumeration Date | 01/06/2017 |
| Last Update Date | 12/29/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932645512 | NPI | - | NPPES |
| 1663061 | Medicaid | AK | |
| 70206 | Other | AK | BUSINESS LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Alaska Island Community Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 102 Harpoon Way, Coffman Cove, AK 99929 Phone: 907-874-4700 Fax: 907-874-4719 |