NPIMap

Organization Active NPI

Southcentralfoundation

Doing business as Tribal Benteh Nuutah Four Directions

  • Multi-Specialty Clinic/Center
  • Wasilla, AK
National Provider Identifier
1750052387
Registry record updated May 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
SOUTHCENTRALFOUNDATION
Doing business as
Tribal Benteh Nuutah Four Directions
Practice address
3223 E Palmer Wasilla Hwy Ste 4
Wasilla, AK 99654-7277
Phone
(907) 729-6799
Fax
(907) 729-8607
NPI assigned
Sep 23, 2021
Last updated
May 19, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2025

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

Authorized official

Name
Jona Tetzloff
Title
Manager
Phone
(907) 729-5083

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

3223 E Palmer Wasilla Hwy Ste 4
Wasilla, AK 99654-7277

Mailing address

7033 E Tudor Rd
Anchorage, AK 99507-1262
Phone (907) 729-5083

Other names 1

  • Tribal Benteh Nuutah Four Directions Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051027000416 TX Part B Supplier - Clinic/Group Practice 5496663627 Receives reassigned benefits from 534 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Anchorage, AK; Chugiak, AK; Fairbanks, AK; Igiugig, AK; Iliamna, AK; Kockhanok, AK; McGrath, AK; Nondalton, AK…

National Provider Directory

National Provider Directory
Tax ID family
Southcentral Foundation PDN103 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

3223 E Palmer Wasilla Hwy
Ste 4
Wasilla, AK 99654
Phone (907) 631-6300

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1632355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747612800000",
    "number": "1750052387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7033 E TUDOR RD",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995071262",
            "telephone_number": "907-729-5083",
            "fax_number": "907-729-5180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3223 E PALMER WASILLA HWY STE 4",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547277",
            "telephone_number": "907-729-6799",
            "fax_number": "907-729-8607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHCENTRALFOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-23",
        "last_updated": "2025-05-19",
        "certification_date": "2025-05-19",
        "status": "A",
        "authorized_official_last_name": "TETZLOFF",
        "authorized_official_first_name": "JONA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "907-729-5083"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tribal Benteh Nuutah Four Directions",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wasilla, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2025; 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.