Provider Demographics
NPI:1033323605
Name:SOUTHEAST ALASKA REGIONAL HEALTH CONSORTIUM
Entity Type:Organization
Organization Name:SOUTHEAST ALASKA REGIONAL HEALTH CONSORTIUM
Other - Org Name:YAKUTAT COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NEUMEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-463-4000
Mailing Address - Street 1:3100 CHANNEL DR
Mailing Address - Street 2:STE 300
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801
Mailing Address - Country:US
Mailing Address - Phone:907-463-4074
Mailing Address - Fax:907-463-1510
Practice Address - Street 1:712 OCEAN CAPE ROAD
Practice Address - Street 2:
Practice Address - City:YAKUTAT
Practice Address - State:AK
Practice Address - Zip Code:99689
Practice Address - Country:US
Practice Address - Phone:907-784-3275
Practice Address - Fax:907-784-3263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2017-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK70206261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKTEZ163Medicare PIN
AK020027Medicare Oscar/Certification
AKMDG632Medicare ID - Type UnspecifiedCHAP GROUP #