Provider Demographics
NPI:1558570648
Name:ALASKA NATIVE TRIBAL HEALTH CONSORTIUM
Entity Type:Organization
Organization Name:ALASKA NATIVE TRIBAL HEALTH CONSORTIUM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GINAMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STRUBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-729-2453
Mailing Address - Street 1:4000 AMBASSADOR DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5909
Mailing Address - Country:US
Mailing Address - Phone:907-729-2460
Mailing Address - Fax:907-729-2454
Practice Address - Street 1:4315 DIPLOMACY DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5926
Practice Address - Country:US
Practice Address - Phone:907-729-3971
Practice Address - Fax:907-729-1542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK255468261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHS13ASMedicaid
AKHS13ASMedicaid