Provider Demographics
NPI:1326047044
Name:KODIAK ISLAND HEALTH CARE FOUNDATION
Entity Type:Organization
Organization Name:KODIAK ISLAND HEALTH CARE FOUNDATION
Other - Org Name:KODIAK COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-481-5002
Mailing Address - Street 1:1911 E REZANOF DR.
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615
Mailing Address - Country:US
Mailing Address - Phone:907-481-5000
Mailing Address - Fax:907-481-5030
Practice Address - Street 1:1911 E REZANOF DR.
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615
Practice Address - Country:US
Practice Address - Phone:907-481-5000
Practice Address - Fax:907-481-5030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK297211173000000X, 261QF0400X
261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRH462FQMedicaid
AK021822Medicare Oscar/Certification
AK021882Medicare Oscar/Certification