Provider Demographics
NPI:1053302620
Name:NINILCHIK EMERGENCY SERVICES
Entity Type:Organization
Organization Name:NINILCHIK EMERGENCY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:W
Authorized Official - Last Name:TAGGART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-567-1098
Mailing Address - Street 1:15763 KINGSLEY RD
Mailing Address - Street 2:P.O.BOX 39446
Mailing Address - City:NINILCHIK
Mailing Address - State:AK
Mailing Address - Zip Code:99639-9759
Mailing Address - Country:US
Mailing Address - Phone:907-567-1098
Mailing Address - Fax:907-567-1098
Practice Address - Street 1:15763 KINGSLEY RD
Practice Address - Street 2:
Practice Address - City:NINILCHIK
Practice Address - State:AK
Practice Address - Zip Code:99639-9759
Practice Address - Country:US
Practice Address - Phone:907-567-1098
Practice Address - Fax:907-567-1098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK50953416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKGA1230Medicaid
AK153029Medicare ID - Type Unspecified