Provider Demographics
NPI:1316180029
Name:YUKON KUSKOKWIM HEALTH CORPORATION
Entity Type:Organization
Organization Name:YUKON KUSKOKWIM HEALTH CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:
Authorized Official - Last Name:PELTOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-543-6020
Mailing Address - Street 1:4700 BUSINESS PARK BLVD STE E25
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-7176
Mailing Address - Country:US
Mailing Address - Phone:907-543-6000
Mailing Address - Fax:907-543-6117
Practice Address - Street 1:49 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:HOOPER BAY
Practice Address - State:AK
Practice Address - Zip Code:99604
Practice Address - Country:US
Practice Address - Phone:907-758-4519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-10
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service