City of Galena

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

CITY OF GALENA

Doing business as

Edgar Nollner Helath Center

Practice address

74 Ruby Road
Ruby, AK 99768-0074

Phone

(907) 468-4433

Fax

(907) 468-4411

NPI assigned

Jul 17, 2008

Last updated

Jul 17, 2008By 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

Cathy Anne Desanto, ANP

Title

Executive Director

Phone

(907) 656-2366

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Edgar Nollner Helath Center Doing business as

Tax ID family

City of Galena5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

• City of Galena

  dba Edgar Nollner Helath Center

  • Federally Qualified Health Center (FQHC)
  • Huslia, AK
  • NPI 1285898478
  NPD tax ID
• City of Galena

  dba Edgar Nollner Health Center

  • Federally Qualified Health Center (FQHC)
  • Nulato, AK
  • NPI 1386808582
  NPD tax ID
• City of Galena

  dba Edgar Nollner Health Center

  • Federally Qualified Health Center (FQHC)
  • Koyukuk, AK
  • NPI 1568626760
  NPD tax ID
• City of Galena

  dba Edgar Nollner Health Center

  • Federally Qualified Health Center (FQHC)
  • Kaltag, AK
  • NPI 1669636866
  NPD tax ID

Practitioners 1

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.

• Krystie Simon

  • Community Health Worker
  • Ruby, AK
  • NPI 1861829798
  NPD (past)

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

{
    "created_epoch": "1216252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216252800000",
    "number": "1487818639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 ANTOSKI AVENUE",
            "city": "GALENA",
            "state": "AK",
            "postal_code": "997410077",
            "telephone_number": "907-656-2366",
            "fax_number": "907-656-1525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "74 RUBY ROAD",
            "city": "RUBY",
            "state": "AK",
            "postal_code": "997680074",
            "telephone_number": "907-468-4433",
            "fax_number": "907-468-4411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF GALENA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-17",
        "last_updated": "2008-07-17",
        "status": "A",
        "authorized_official_last_name": "DESANTO",
        "authorized_official_first_name": "CATHY",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "907-656-2366",
        "authorized_official_credential": "ANP"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CL4429",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edgar Nollner Helath Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Donald Jr Victor Honea
• Merreline Kangas
• Krystie Simon

• Federally Qualified Health Center (FQHC) in Ruby, AK
• Providers in Ruby, AK by specialty
• Federally Qualified Health Center (FQHC) in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2008; 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.