Provider Demographics
NPI:1154487817
Name:CITY OF KETCHIKAN
Entity Type:Organization
Organization Name:CITY OF KETCHIKAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:NEWELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:907-225-3111
Mailing Address - Street 1:PO BOX 3510
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-3510
Mailing Address - Country:US
Mailing Address - Phone:907-225-3111
Mailing Address - Fax:907-228-5608
Practice Address - Street 1:334 FRONT ST
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-6431
Practice Address - Country:US
Practice Address - Phone:907-225-3111
Practice Address - Fax:907-228-5608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKTR0301Medicaid
590003575OtherRAILROAD MEDICARE PTAN
590003575OtherRAILROAD MEDICARE PTAN
W00133Medicare ID - Type Unspecified