Provider Demographics
NPI:1336178847
Name:SELDOVIA VILLAGE TRIBE
Entity Type:Organization
Organization Name:SELDOVIA VILLAGE TRIBE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVTHW DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:READ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-226-2208
Mailing Address - Street 1:880 E END RD
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-7201
Mailing Address - Country:US
Mailing Address - Phone:907-226-2228
Mailing Address - Fax:907-226-2230
Practice Address - Street 1:880 E END RD
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7201
Practice Address - Country:US
Practice Address - Phone:907-226-2228
Practice Address - Fax:907-226-2230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1000849Medicaid
AK1003814Medicaid
AK1003814Medicaid