Provider Demographics
NPI:1336274778
Name:FAMILY HEALTH CENTER, PC
Entity Type:Organization
Organization Name:FAMILY HEALTH CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-745-1777
Mailing Address - Street 1:425 E DAHLIA AVE
Mailing Address - Street 2:SUITE L
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6414
Mailing Address - Country:US
Mailing Address - Phone:907-745-1777
Mailing Address - Fax:907-745-0226
Practice Address - Street 1:425 E DAHLIA AVE
Practice Address - Street 2:SUITE L
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6414
Practice Address - Country:US
Practice Address - Phone:907-745-1777
Practice Address - Fax:907-745-0226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK75324363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1004374Medicaid
AKK152572Medicare ID - Type Unspecified