Provider Demographics
NPI:1730322785
Name:COUNCIL OF ATHABASCAN TRIBAL GOVERNMENTS
Entity Type:Organization
Organization Name:COUNCIL OF ATHABASCAN TRIBAL GOVERNMENTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-662-7529
Mailing Address - Street 1:PO BOX 33
Mailing Address - Street 2:
Mailing Address - City:FORT YUKON
Mailing Address - State:AK
Mailing Address - Zip Code:99740-0033
Mailing Address - Country:US
Mailing Address - Phone:907-662-2460
Mailing Address - Fax:907-662-2709
Practice Address - Street 1:101 SPRUCE STREET
Practice Address - Street 2:
Practice Address - City:FORT YUKON
Practice Address - State:AK
Practice Address - Zip Code:99740-0309
Practice Address - Country:US
Practice Address - Phone:907-662-2460
Practice Address - Fax:907-662-2709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMDG670Medicaid