Provider Demographics
NPI:1679026702
Name:NORTON SOUND HEALTH CORPORATION
Entity Type:Organization
Organization Name:NORTON SOUND HEALTH CORPORATION
Other - Org Name:NORTON SOUND HEALTH CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V. P HOSPITAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFSTETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-443-3311
Mailing Address - Street 1:1000 GREG KRUCHECK AVE
Mailing Address - Street 2:
Mailing Address - City:NOME
Mailing Address - State:AK
Mailing Address - Zip Code:99762-0966
Mailing Address - Country:US
Mailing Address - Phone:907-443-3311
Mailing Address - Fax:907-443-8155
Practice Address - Street 1:1000 GREG KRUCHECK AVE
Practice Address - Street 2:
Practice Address - City:NOME
Practice Address - State:AK
Practice Address - Zip Code:99762-0966
Practice Address - Country:US
Practice Address - Phone:907-443-3311
Practice Address - Fax:907-443-8155
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIABETIC PROGRAM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKDTND76133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDTND76OtherLICENSE