Provider Demographics
NPI:1659570414
Name:CHILKAT VALLEY MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:CHILKAT VALLEY MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:KEIRSTEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-766-3701
Mailing Address - Street 1:PO BOX 389
Mailing Address - Street 2:
Mailing Address - City:HAINES
Mailing Address - State:AK
Mailing Address - Zip Code:99827-0389
Mailing Address - Country:US
Mailing Address - Phone:907-766-3701
Mailing Address - Fax:907-766-3709
Practice Address - Street 1:138 SECOND AVE. S
Practice Address - Street 2:
Practice Address - City:HAINES
Practice Address - State:AK
Practice Address - Zip Code:99827-0389
Practice Address - Country:US
Practice Address - Phone:907-766-3701
Practice Address - Fax:907-766-3709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK905468261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care