Provider Demographics
NPI:1083038640
Name:MT SANFORD TRIBAL CONSORTIUM
Entity Type:Organization
Organization Name:MT SANFORD TRIBAL CONSORTIUM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-822-5399
Mailing Address - Street 1:PO BOX 357
Mailing Address - Street 2:
Mailing Address - City:CHISTOCHINA
Mailing Address - State:AK
Mailing Address - Zip Code:99586-0357
Mailing Address - Country:US
Mailing Address - Phone:907-822-5399
Mailing Address - Fax:
Practice Address - Street 1:34 MILE TOK HIGHWAY
Practice Address - Street 2:
Practice Address - City:GAKONA
Practice Address - State:AK
Practice Address - Zip Code:99586-0357
Practice Address - Country:US
Practice Address - Phone:907-822-5399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare