NPIMap

Organization Active NPI

Maniilaq Association

  • Dentist
  • Kotzebue, AK
National Provider Identifier
1003010042
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
234051 Issued in AK
Legal business name
MANIILAQ ASSOCIATION
Practice address
436 5TH & Ted Stevens Way
Kotzebue, AK 99752
Phone
(907) 442-3321
Fax
(907) 442-7250
NPI assigned
Jun 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Paul Hanson
Title
Medical Staff Services
Phone
(907) 442-3321

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 234051 AK Primary

Addresses

Primary practice location

436 5TH & Ted Stevens Way
Kotzebue, AK 99752

Mailing address

PO Box 43
Kotzebue, AK 99752-0043
Phone (907) 442-3321

Other identifiers 1

IdentifierTypeStateIssuer
DDG111MedicaidAK

Other names 1

  • Maniilaq Health Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Buckland Clinic45 organizations share this tax ID, including this one

Other organizations with this tax ID 44

Organizations that report the same tax identification number in the National Provider Directory.

View all 44

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1003010042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 43",
            "city": "KOTZEBUE",
            "state": "AK",
            "postal_code": "997520043",
            "telephone_number": "907-442-3321",
            "fax_number": "907-442-7250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "436 5TH & TED STEVENS WAY",
            "city": "KOTZEBUE",
            "state": "AK",
            "postal_code": "99752",
            "telephone_number": "907-442-3321",
            "fax_number": "907-442-7250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANIILAQ ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HANSON",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "MEDICAL STAFF SERVICES",
        "authorized_official_telephone_number": "907-442-3321"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "AK",
            "license": "234051",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DDG111",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maniilaq Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kotzebue, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.