Interior Community Health Center Dental Prog

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

INTERIOR COMMUNITY HEALTH CENTER DENTAL PROG

Practice address

1606 23Rd Ave
Fairbanks, AK 99701-6407

Phone

(907) 455-4567

NPI assigned

Apr 18, 2007

Organization subpart

No

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

Authorized official

Name

Cheryl Kilgore

Title

Executive Director

Phone

(907) 455-4567

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AK

Enrollment records 1

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Interior Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Fairbanks, AK
  • NPI 1457552903

  O20031105000421

  Same enrollment
• Interior Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Fairbanks, AK
  • NPI 1588739015

  O20031105000421

  Same enrollment
• Interior Community Health Center

  • Primary Care Clinic/Center
  • Healy, AK
  • NPI 1609942754

  O20031105000421

  Same enrollment

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1124244181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1606 23RD AVE",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997016407",
            "telephone_number": "907-455-4567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1606 23RD AVE",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997016407",
            "telephone_number": "907-455-4567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERIOR COMMUNITY HEALTH CENTER DENTAL PROG",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KILGORE",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "907-455-4567"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NUMBER",
            "identifier": "02-1810",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Interior Alaska DBT & Counseling, LLC
• Interior Alaska Orthopedic & Sports Medicine Inc
• Interior Birthing Center LLC
• Interior Community Health Center
• Interior Community Health Center
• Interior Eye Center, LLC
• Interior Medical Supply LLC
• Interior Mobility Systems LLC
• Interior Mobility Systems, LLC
• Interior Women'S Health, LLC

• Dental Clinic/Center in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Dental Clinic/Center in Alaska

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.