Provider Demographics
NPI:1811220767
Name:EDGAR NOLLNER HEALTH CENTER
Entity Type:Organization
Organization Name:EDGAR NOLLNER HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR QUALITY MANAGEMENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-452-8251
Mailing Address - Street 1:PO BOX 77
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:AK
Mailing Address - Zip Code:99741-0077
Mailing Address - Country:US
Mailing Address - Phone:907-656-1366
Mailing Address - Fax:907-656-1525
Practice Address - Street 1:77 ANTOSKI AVE
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:AK
Practice Address - Zip Code:99741-0077
Practice Address - Country:US
Practice Address - Phone:907-656-1366
Practice Address - Fax:907-656-1525
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TANANA CHIEFS CONFERENCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health