Provider Demographics
NPI:1346677754
Name:CROSS ROAD HEALTH MINISTRIES, INC.
Entity Type:Organization
Organization Name:CROSS ROAD HEALTH MINISTRIES, INC.
Other - Org Name:INTERIOR ALASKA MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-822-5686
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:GLENNALLEN
Mailing Address - State:AK
Mailing Address - Zip Code:99588-0589
Mailing Address - Country:US
Mailing Address - Phone:907-822-3203
Mailing Address - Fax:
Practice Address - Street 1:2730 ALASKA HIGHWAY
Practice Address - Street 2:
Practice Address - City:DELTA JUNCTION
Practice Address - State:AK
Practice Address - Zip Code:99737
Practice Address - Country:US
Practice Address - Phone:907-822-5686
Practice Address - Fax:907-822-5684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-30
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK103000261QF0400X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care