Bountiful
Organization Active NPI Meals Provider · Ketchikan, AK
NPI 1114736899 · NPPES record last updated Jan 6, 2025
Key facts
- NPI
- 1114736899
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Meals Provider 174200000X
- Legal business name
- BOUNTIFUL
- Practice address
- 25 Jefferson Way Ste 102
Ketchikan, AK 99901-5953 - Phone
- (201) 259-0289
- Fax
- (973) 215-2052
- NPI assigned
- Jan 6, 2025
- Organization subpart
- No
Authorized official
- Name
- Dr. Kevin Arthur Hall, MD
- Title
- Owner
- Phone
- (201) 259-0289
Practitioners 2
-
Kevin Arthur Hall, M.D.
-
Stephanie Mae Johnson, LCSW
National Provider Directory
Locations
25 Jefferson Way
Ste 102
Ketchikan, AK 99901
Phone (201) 259-0289
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Meals Provider | 174200000X | Yes |
Addresses
Primary practice location
25 Jefferson Way Ste 102
Ketchikan, AK 99901-5953
Mailing address
25 Jefferson Way Ste 102
Ketchikan, AK 99901-5953
Phone (201) 259-0289
Other names
- CapitolMed LLC dba Polaris Healthcare
Other providers in Ketchikan, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 6, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.