Creekside Family Health Clinic Inc

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

CREEKSIDE FAMILY HEALTH CLINIC INC

Practice address

320 Bawden St
Suite #313
Ketchikan, AK 99901-6573

Phone

(907) 220-9982

Fax

(907) 220-9972

NPI assigned

May 31, 2011

Last updated

Nov 13, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. John Hill

Title

Office Manager

Phone

(907) 220-9982

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AK

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shawna Strouth-Shaw, NP

  • Family Nurse Practitioner
  • Ketchikan, AK
  • NPI 1205335809
  Medicare reassignment NPD
• Carol L Alley, MD

  • Family Medicine Physician
  • Carson City, NV
  • NPI 1003879693
  NPD (past)

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

{
    "created_epoch": "1306800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352764800000",
    "number": "1477847184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3521 LOMITA BLVD",
            "address_2": "SUITE #103",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905055039",
            "telephone_number": "310-534-9131",
            "fax_number": "310-534-9132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 BAWDEN ST",
            "address_2": "SUITE #313",
            "city": "KETCHIKAN",
            "state": "AK",
            "postal_code": "999016573",
            "telephone_number": "907-220-9982",
            "fax_number": "907-220-9972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREEKSIDE FAMILY HEALTH CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-31",
        "last_updated": "2012-11-13",
        "status": "A",
        "authorized_official_last_name": "HILL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "907-220-9982",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MPG0359",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP0504",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Corrao
• Bryan Cothren, M.D.
• Brandy Cotter
• Estelle Cowie, MA, CDCS
• Jamie Cox
• Cynthia Wornstaff NP LLC
• Meghan Dahlquist
• Torijaun D'Aundre Dallas, MD
• Sarah Daly
• Cyrus Daniel

• Family Nurse Practitioner in Ketchikan, AK
• Providers in Ketchikan, AK by specialty
• Family Nurse Practitioner in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2012; 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.