Native Village of Tyonek

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

261Q00000X Issued in AK

Legal business name

NATIVE VILLAGE OF TYONEK

Practice address

73 C Street
Tyonek, AK 99682

Phone

(907) 583-2461

Fax

(907) 583-2155

NPI assigned

Sep 20, 2012

Last updated

Sep 20, 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. David Matthew Rogers

Title

Tribal Administrator

Phone

(907) 583-2201

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1348099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348099200000",
    "number": "1689925463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 82009",
            "city": "TYONEK",
            "state": "AK",
            "postal_code": "996820009",
            "telephone_number": "907-583-2461",
            "fax_number": "907-583-2155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "73 C STREET",
            "city": "TYONEK",
            "state": "AK",
            "postal_code": "99682",
            "telephone_number": "907-583-2461",
            "fax_number": "907-583-2155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NATIVE VILLAGE OF TYONEK",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-20",
        "last_updated": "2012-09-20",
        "status": "A",
        "authorized_official_last_name": "ROGERS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "TRIBAL ADMINISTRATOR",
        "authorized_official_telephone_number": "907-583-2201",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "AK",
            "license": "261Q00000X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chrystal Marie Moon, CHA IV
• Southcentral Foundation (Indian Creek BSD Clinic)
• Southcentral Foundation (Tribal- Indian Creek Health Center)
• Southcentral Foundation (Dental- Indian Creek Dental Clinic)
• Robert Anthony Stephan Jr.
• Kimberly Shayd Ulery, CHA III

• Clinic/Center in Tyonek, AK
• Providers in Tyonek, AK by specialty
• Clinic/Center in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2012; 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.