Eastern Aleutian Tribes, Inc.
Organization Active NPI Community Health Clinic/Center · Nelson Lagoon, AK
NPI 1003970062 · NPPES record last updated May 16, 2018
Key facts
- NPI
- 1003970062
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Health Clinic/Center 261QC1500X
- Legal business name
- EASTERN ALEUTIAN TRIBES, INC.
- Practice address
- 40 Main Street
Nelson Lagoon, AK 99571 - Phone
- (907) 989-2202
- Fax
- (907) 277-1436
- NPI assigned
- Dec 21, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Jennifer Dahle Harrison
- Title
- Executive Director
- Phone
- (907) 277-1440
Other NPIs on the same Medicare enrollment 9
Practitioners 39
-
Olegario Carrillo, PA-C
-
Daniel Hartman, MD
-
Melodie Isgro, MD
-
Katherine Grace Van Atta, PA-C, CNM
-
Thai Gene Verzone, PA-C
-
Miles Ferdi Ardaman, M.D.
-
Heather Sevan Atamian, PA-C
-
Robert Lee Fenton, PA-C
-
Judy Lynn Hoffman, N.P.
-
Jeremy Loving, PA-C
-
Robert Oliver Meyer, FNP
-
Dennis Page, NP
-
Matthew J Pitera, M.D.
-
Benjamin Ramos Anderson, LCSW
-
Crystal Bleu Smith, LCSW
-
Susan A Bryan, ANP
-
John Curtis, CT
-
Dianna Fornasier, RN CDCES
-
Nicole D Hoblet, CHAP
-
Sarah P Howell, R.N.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AK, TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040331000995 | AK | Part B Supplier - Clinic/Group Practice | 2860301884 |
Receives reassigned benefits from 19 practitioners 9 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Adak, AK; Whittier, AK; Sand Point, AK; Nelson Lagoon, AK; False Pass, AK; Cold Bay, AK; Akutan, AK; King Cove, AK |
| O20180413000684 | TX | Part B Supplier - Clinic/Group Practice | 2860301884 |
Receives reassigned benefits from 80 practitioners 7 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Cold Bay, AK; Sand Point, AK; Nelson Lagoon, AK; King Cove, AK; Akutan, AK; Adak, AK; False Pass, AK |
National Provider Directory
Locations
721 Sesame St
Ste 2C
Anchorage, AK 99503
Phone (907) 563-1414
3380 C St
Ste 107
Anchorage, AK 99503
Phone (907) 277-1440
100 Kenai St
Unit 301
Whittier, AK 99693
Phone (907) 472-2303
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Clinic/Center | 261QC1500X | AK | Yes |
Addresses
Primary practice location
40 Main Street
Nelson Lagoon, AK 99571
Mailing address
3380 C Street
Suite 100
Anchorage, AK 99503
Phone (907) 277-1440
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CL 3917 | Medicaid | AK |
Other providers in Nelson Lagoon, AK
All providers in Nelson Lagoon, AK · Community Health Clinic/Center in Alaska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 16, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.