Provider Demographics
NPI:1033712278
Name:SOUTHCENTRAL FOUNDATION
Entity Type:Organization
Organization Name:SOUTHCENTRAL FOUNDATION
Other - Org Name:MCGRATH REGIONAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:JONA
Authorized Official - Middle Name:
Authorized Official - Last Name:TETZLOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-729-5083
Mailing Address - Street 1:7033 E TUDOR RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1262
Mailing Address - Country:US
Mailing Address - Phone:907-729-6580
Mailing Address - Fax:907-729-8607
Practice Address - Street 1:10 DNR RD
Practice Address - Street 2:
Practice Address - City:MCGRATH
Practice Address - State:AK
Practice Address - Zip Code:99627
Practice Address - Country:US
Practice Address - Phone:907-729-4987
Practice Address - Fax:907-729-8607
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHCENTRAL FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-19
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health