Provider Demographics
NPI:1376520692
Name:ILIULIUK FAMILY AND HEALTH SERVICES INC
Entity type:Organization
Organization Name:ILIULIUK FAMILY AND HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-525-8450
Mailing Address - Street 1:PO BOX 144
Mailing Address - Street 2:
Mailing Address - City:UNALASKA
Mailing Address - State:AK
Mailing Address - Zip Code:99685-0144
Mailing Address - Country:US
Mailing Address - Phone:907-581-1202
Mailing Address - Fax:907-581-2331
Practice Address - Street 1:34 LAVELLE COURT
Practice Address - Street 2:
Practice Address - City:UNALASKA
Practice Address - State:AK
Practice Address - Zip Code:99685-0144
Practice Address - Country:US
Practice Address - Phone:907-581-1202
Practice Address - Fax:907-581-2331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QC1500X, 261QM1300X, 261QF0400X
AK147861363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity HealthGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRH522FQMedicaid
AKRH522FQMedicaid