Provider Demographics
NPI:1043514177
Name:CITY OF KLAWOCK
Entity Type:Organization
Organization Name:CITY OF KLAWOCK
Other - Org Name:KLAWOCK EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OF EMS
Authorized Official - Prefix:
Authorized Official - First Name:JATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NALLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-755-2222
Mailing Address - Street 1:PO BOX 311073
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36331-1073
Mailing Address - Country:US
Mailing Address - Phone:877-346-5286
Mailing Address - Fax:866-335-0242
Practice Address - Street 1:360 ANCHORAGE ST
Practice Address - Street 2:
Practice Address - City:KLAWOCK
Practice Address - State:AK
Practice Address - Zip Code:99925-0000
Practice Address - Country:US
Practice Address - Phone:907-755-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK40703416A0800X
AK20703416L0300X, 3416S0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No3416A0800XTransportation ServicesAmbulanceAir Transport
No3416S0300XTransportation ServicesAmbulanceWater Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKGA6150Medicaid
AKGA6150Medicaid