Isc Ketchikan-Juneau Detachment

Primary specialty

Military/U.S. Coast Guard Outpatient Clinic/CenterTaxonomy code 261QM1100X

Legal business name

ISC KETCHIKAN-JUNEAU DETACHMENT

Practice address

709 W 9TH St
Uscg Medical Room 627
Juneau, AK 99801-1807

Phone

(907) 463-2140

NPI assigned

Dec 20, 2005

Last updated

Aug 22, 2020By 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

Juan Esteban Palacio, M.D.

Title

Chief of Health Services

Phone

(907) 463-2140

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1135036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497731590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "709 W 9TH ST",
            "address_2": "USCG MEDICAL ROOM 627",
            "city": "JUNEAU",
            "state": "AK",
            "postal_code": "998011807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 W 9TH ST",
            "address_2": "USCG MEDICAL ROOM 627",
            "city": "JUNEAU",
            "state": "AK",
            "postal_code": "998011807",
            "telephone_number": "907-463-2140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISC KETCHIKAN-JUNEAU DETACHMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PALACIO",
        "authorized_official_first_name": "JUAN",
        "authorized_official_middle_name": "ESTEBAN",
        "authorized_official_title_or_position": "CHIEF OF HEALTH SERVICES",
        "authorized_official_telephone_number": "907-463-2140",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Military/U.S. Coast Guard Outpatient",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.