NPIMap

Organization Active NPI

Ketchikan Indian Corporation

  • Dental Clinic/Center
  • Ketchikan, AK
National Provider Identifier
1396153649
Registry record updated Jul 31, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
378 Issued in AK
Legal business name
KETCHIKAN INDIAN CORPORATION
Practice address
2960 Tongass Ave
Ketchikan, AK 99901-5742
Phone
(907) 228-9200
Fax
(800) 887-8796
NPI assigned
Jul 31, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2014

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

Authorized official

Name
Mr. Steve F Hudson
Title
Health Administrator
Phone
(907) 228-9253

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 378 AK Primary

Addresses

Primary practice location

2960 Tongass Ave
Ketchikan, AK 99901-5742

Mailing address

2960 Tongass Ave
Ketchikan, AK 99901-5742
Phone (907) 228-9200

Other identifiers 1

IdentifierTypeStateIssuer
378OtherAKBUSINESS PROFESSIONAL LICENSE

Other names 1

  • KIC TRIBAL HEALTH CLINIC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Kicthc Behavioral Health Department7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

NPI Registry JSON

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

{
    "created_epoch": "1406764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406764800000",
    "number": "1396153649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2960 TONGASS AVE",
            "city": "KETCHIKAN",
            "state": "AK",
            "postal_code": "999015742",
            "telephone_number": "907-228-9200",
            "fax_number": "800-887-8796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2960 TONGASS AVE",
            "city": "KETCHIKAN",
            "state": "AK",
            "postal_code": "999015742",
            "telephone_number": "907-228-9200",
            "fax_number": "800-887-8796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETCHIKAN INDIAN CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-31",
        "last_updated": "2014-07-31",
        "status": "A",
        "authorized_official_last_name": "HUDSON",
        "authorized_official_first_name": "STEVE",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "HEALTH ADMINISTRATOR",
        "authorized_official_telephone_number": "907-228-9253",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "AK",
            "license": "378",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUSINESS PROFESSIONAL  LICENSE",
            "identifier": "378",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KIC TRIBAL HEALTH CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ketchikan, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2014; 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.