Tok Community Clinic, Incorporated
Organization Active NPI Ambulance · Tok, AK
NPI 1952304271 · NPPES record last updated Dec 6, 2017
Key facts
- NPI
- 1952304271
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ambulance 341600000X
- License
- 6185 (AK)
- Legal business name
- TOK COMMUNITY CLINIC, INCORPORATED
- Practice address
- Mile 124 Tok Cutoff
Tok, AK 99780-0033 - Phone
- (907) 883-5873
- Fax
- (907) 883-3640
- NPI assigned
- May 31, 2005
- Organization subpart
- No
Authorized official
- Name
- Jack Le Roy Rutledge
- Title
- Agent
- Phone
- (907) 883-5873
Corporate family (same tax ID) 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120316000324 | AK | Part B Supplier - Ambulance Service Supplier | 7113186727 | Practice locations: Tok, AK |
National Provider Directory
- Tax ID family
- Tok Community Clinic Incorporated
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulance | 341600000X | 6185 | AK | Yes |
Addresses
Primary practice location
Mile 124 Tok Cutoff
Tok, AK 99780-0033
Mailing address
PO Box 33
Tok, AK 99780-0033
Phone (907) 883-5873
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GA6185 | Medicaid | AK |
Other providers in Tok, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 6, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.