Provider Demographics
NPI:1568496602
Name:MANIILAQ HEALTH CENTER
Entity Type:Organization
Organization Name:MANIILAQ HEALTH CENTER
Other - Org Name:MANIILAQ ASSOCIATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLANCY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-442-7380
Mailing Address - Street 1:479 TED STEVENS WAY
Mailing Address - Street 2:APARTMENT. B 8
Mailing Address - City:KOTZEBUE
Mailing Address - State:AK
Mailing Address - Zip Code:99752
Mailing Address - Country:US
Mailing Address - Phone:907-442-2865
Mailing Address - Fax:
Practice Address - Street 1:436 & 5TH TED STEVENS WAY
Practice Address - Street 2:
Practice Address - City:KOTZEBUE
Practice Address - State:AK
Practice Address - Zip Code:99752
Practice Address - Country:US
Practice Address - Phone:907-442-2865
Practice Address - Fax:907-442-7233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK157261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care