Provider Demographics
NPI:1619005683
Name:CITY OF BETHEL
Entity Type:Organization
Organization Name:CITY OF BETHEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT FINANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-543-1375
Mailing Address - Street 1:PO BOX 1388
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:AK
Mailing Address - Zip Code:99559-1388
Mailing Address - Country:US
Mailing Address - Phone:907-543-1375
Mailing Address - Fax:907-543-3817
Practice Address - Street 1:320 CHIEF EDDIE HOFFMAN HWY
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:AK
Practice Address - Zip Code:99559
Practice Address - Country:US
Practice Address - Phone:907-543-2131
Practice Address - Fax:907-543-2702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA01203416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKTR0217Medicaid
AKK0000RGCLGMedicare PIN