Provider Demographics
NPI:1821304379
Name:MANUKA HEALTH CLINIC, LLC
Entity Type:Organization
Organization Name:MANUKA HEALTH CLINIC, LLC
Other - Org Name:MANUKA HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCOGGIN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PHD, ANP-C
Authorized Official - Phone:907-222-6970
Mailing Address - Street 1:3705 ARCTIC BLVD # 420
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-5774
Mailing Address - Country:US
Mailing Address - Phone:907-222-6970
Mailing Address - Fax:888-768-0925
Practice Address - Street 1:721 SESAME ST STE 1D
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-6632
Practice Address - Country:US
Practice Address - Phone:907-222-6970
Practice Address - Fax:888-768-3890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-23
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK570261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1570754Medicaid