Provider Demographics
NPI:1740294081
Name:METLAKATLA INDIAN COMMUNITY
Entity type:Organization
Organization Name:METLAKATLA INDIAN COMMUNITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SERVICE UNIT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:ASKREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-886-6601
Mailing Address - Street 1:PO BOX 439
Mailing Address - Street 2:
Mailing Address - City:METLAKATLA
Mailing Address - State:AK
Mailing Address - Zip Code:99926-0439
Mailing Address - Country:US
Mailing Address - Phone:907-886-6601
Mailing Address - Fax:907-886-6976
Practice Address - Street 1:563 BRENDIBLE STREET
Practice Address - Street 2:
Practice Address - City:METLAKATLA
Practice Address - State:AK
Practice Address - Zip Code:99926
Practice Address - Country:US
Practice Address - Phone:907-886-6601
Practice Address - Fax:907-886-6976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No3416S0300XTransportation ServicesAmbulanceWater TransportGroup - Multi-Specialty
No364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPH4579Medicaid
AKMS4579Medicaid
AKCL0299Medicaid
AKTR4579Medicaid
TXHSZ079Medicare ID - Type UnspecifiedTRIBAL CLINIC
AKTR4579Medicaid