Provider Demographics
NPI:1689719825
Name:YUKON-KUSKOKWIM HEALTH CORPORATION
Entity Type:Organization
Organization Name:YUKON-KUSKOKWIM HEALTH CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WINKELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-543-6000
Mailing Address - Street 1:PO BOX 287
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:AK
Mailing Address - Zip Code:99559-0287
Mailing Address - Country:US
Mailing Address - Phone:907-543-6000
Mailing Address - Fax:907-543-6306
Practice Address - Street 1:700 CHIEF EDDIE HOFFMAN HWY
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:AK
Practice Address - Zip Code:99559-0827
Practice Address - Country:US
Practice Address - Phone:907-543-6000
Practice Address - Fax:907-543-6306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1996881OtherPK
AKPH4141Medicaid