Yukon Kuskokwim Health Corporation
Organization Active NPI Health Service Clinic/Center · Emmonak, AK
NPI 1124201199 · NPPES record last updated Dec 12, 2007
Key facts
- NPI
- 1124201199
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Health Service Clinic/Center 261QH0100X
- Legal business name
- YUKON KUSKOKWIM HEALTH CORPORATION
- Practice address
- 246 Kwiguk Street
Emmonak Subregional Clinic
Emmonak, AK 99581 - Phone
- (907) 543-6000
- Fax
- (907) 543-6117
- NPI assigned
- Dec 12, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- YKHC-EMMONAK SUBREGIONAL CLINIC
Authorized official
- Name
- Mr. Gene Peltola
- Title
- Ceo
- Phone
- (907) 543-6000
Other NPIs on the same Medicare enrollment 5
Practitioners 5
-
Andrew Burnett, PMHNP
-
Mallory Devereaux, PMHNP-BC
-
Kara Dickinson, PMHNP-BC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040407001515 | TX | Part B Supplier - Clinic/Group Practice | 5193718765 |
Receives reassigned benefits from 36 practitioners 5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Bethel, AK; Toksook, AK; St. Mary'S, AK; Hooper Bay, AK; Emmonak, AK; Aniak, AK |
National Provider Directory
- Part of
- Edith Kawagley Memorial
Locations
4700 Business Park Blvd
Anchorage, AK 99503
246 Kwiguk St
Emmonak Subregional Clinic
Emmonak, AK 99581
Phone (907) 949-3500
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Service Clinic/Center | 261QH0100X | Yes |
Addresses
Primary practice location
246 Kwiguk Street
Emmonak Subregional Clinic
Emmonak, AK 99581
Mailing address
4700 Business Park Blvd
Anchorage, AK 99503-7176
Phone (907) 543-6000
Other providers in Emmonak, AK
- Travis J Kassaiuli
- Stella Leopold
- Kimberly A Moore
- Laurentia R Redfox
- Wassilie P Tinker
- Yukon Kuskokwim Health Corporation
All providers in Emmonak, AK · Health Service 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 Dec 12, 2007. 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.