NPIMap

Organization Active NPI

Ketchikan Indian Corporation

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Ketchikan, AK
National Provider Identifier
1699983361
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyTaxonomy code 332800000X
Legal business name
KETCHIKAN INDIAN CORPORATION
Practice address
2960 Tongass Ave
Ketchikan, AK 99901-5742
Phone
(907) 225-0320
Fax
(907) 247-4819
NPI assigned
May 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

Name
Wendy Ross
Title
RCM
Phone
(907) 228-9254

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X Primary

Addresses

Primary practice location

2960 Tongass Ave
Ketchikan, AK 99901-5742

Mailing address

2960 Tongass Ave
Ketchikan, AK 99901-5742
Phone (907) 225-0320

Other identifiers 2

IdentifierTypeStateIssuer
0202325OtherNCPDP NUMBER
PH2696MedicaidAK

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": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1699983361",
    "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": "907-225-0320",
            "fax_number": "907-247-4819"
        },
        {
            "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": "907-225-0320",
            "fax_number": "907-247-4819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETCHIKAN INDIAN CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2023-03-07",
        "certification_date": "2021-04-28",
        "status": "A",
        "authorized_official_last_name": "ROSS",
        "authorized_official_first_name": "WENDY",
        "authorized_official_title_or_position": "RCM",
        "authorized_official_telephone_number": "907-228-9254"
    },
    "taxonomies": [
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP NUMBER",
            "identifier": "0202325",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PH2696",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Mar 7, 2023; 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.