BETHEL FAMILY CLINIC (NPI# 1124078019) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124078019 |
| Entity Type | Organization |
| Organization Name | BETHEL FAMILY CLINIC |
| Practice Address |
631 Main Street Bethel AK 99559-1908 |
| Mailing Address |
Po Box 1908 631 Main Street Bethel AK 99559-1908 |
| Practice Telephone | 9075433773 |
| Practice Fax Number | 9075433545 |
| Mailing Telephone | 9075433773 |
| Mailing Fax Number | 9075433545 |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2018-11-27 |
| Authorized Official Name | SUZANNE NIEMI (FINANCE) |
| Authorized Official Telephone | 9075439852 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | 1029936 | 05 | |
| AK | MEDICARE PART A PTAN | 02-1835 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 631 Main Street, Bethel, AK 995591908 | 9075433773 | 9075433545 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891279097 | Bethel Family Clinic | Clinic/Center | 430 Main Street, Bethel, AK 99559-1908 | 2018-09-24 |
| Street Address |
631 MAIN STREET |
| City | BETHEL |
| State | AK |
| Zip Code | 99559-1908 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952830226 | Brent Clark | Nurse Practitioner | 631 Main Street, Bethel, AK 99559-1908 | 2017-06-08 |
| 1699207126 | Joan Ellen Daniels | Nurse Practitioner | 631 Main Street, Bethel, AK 99559 | 2017-04-03 |
| 1447560248 | Patsy Ann Cooper | Nurse Practitioner | 631 Main Street, Bethel, AK 99559-1908 | 2010-10-14 |
| 1336460245 | Dennis Raines | Counselor | 631 Main Street, Bethel, AK 99559 | 2010-06-15 |
| 1306898200 | Gloria Ann Evans | Nurse Practitioner | 631 Main Street, Bethel, AK 99559 | 2006-05-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194337519 | Michael P Nicolai | Case Manager/Care Coordinator | 829 Chief Eddie Hoffman Hey, Bethel, AK 99559 | 2020-08-18 |
| 1003438508 | Enc Physical Therapy LLC | Physical Therapist | 223 Blackberry Street, Unit A, Bethel, AK 99559 | 2020-05-07 |
| 1780229609 | Laline Knox | Massage Therapist | 107 Alex Hatley Ste 1, Bethel, AK 99559 | 2019-11-14 |
| 1659920502 | Ana Celina Sebastian | Counselor | 1380 Calista Dr, Bethel, AK 99559 | 2019-09-04 |
| 1639730484 | Jerri Linda Moran-gentle | Massage Therapist | 430 A 7th Ave, Bethel, AK 99559 | 2019-06-24 |
| 1528625381 | Jennifer Peeks | Social Worker | 631 4th Ave. & Main St., Bethel, AK 99559 | 2019-05-28 |
| 1710451190 | Mary Theresa Thibeault | Registered Nurse | Bethel Public Health Center, 1490 Eddie Hoffman Highway, Bethel, AK 99559 | 2019-01-18 |
| 1659846210 | Freda Lizann Jimmie | Counselor | 829 Eddie Hoffman Highway, Bethel, AK 99559 | 2018-10-10 |
| 1073093977 | Romeo Mullai | Counselor | 1630 Calista Drive, Bethel, AK 99559 | 2018-08-20 |
| 1235623794 | Brian Justin Moses | Day Training/Habilitation Specialist | 841 Chief Eddie Hoffman Highway, Bethel, AK 99559 | 2018-06-19 |
| Find all providers in zip 99559 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568435345 | Healthreach Community Health Centers | Clinic/Center | 32 Railroad St, Bethel, ME 04217-1367 | 2006-02-10 |
| 1891279097 | Bethel Family Clinic | Clinic/Center | 430 Main Street, Bethel, AK 99559-1908 | 2018-09-24 |
| 1659701571 | Gifford Health Care, Inc | Clinic/Center | 1823 Vt Rte 107, Bethel, VT 05032-9107 | 2013-11-13 |
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| 1821511064 | Cross Road Health Ministries, Inc. | Clinic/Center | 187 Glenn Highway, Glennallen, AK 99588-0589 | 2017-07-19 |
| 1568902583 | Sunshine Community Health Center, Inc | Clinic/Center | 42728 S Parks Highway, Talkeetna, AK 99676 | 2017-02-24 |
| 1467991455 | Sunshine Community Health Center, Inc | Clinic/Center | 13930 E Timberwolf Loop, Talkeetna, AK 99676 | 2017-02-23 |
| 1477003978 | Alaska Island Community Services | Clinic/Center | 110 Lynch Street, Wrangell, AK 99929 | 2016-10-07 |
| 1679718019 | Camai Community Health Center, Inc. | Clinic/Center | # 2 School Rd, Naknek, AK 99633-0211 | 2008-12-15 |
| 1487818639 | City of Galena | Clinic/Center | 74 Ruby Road, Ruby, AK 99768-0074 | 2008-07-17 |
| 1568626760 | City of Galena | Clinic/Center | 30 Koyukuk Lane, Koyukuk, AK 99754-0030 | 2008-07-16 |
| 1669636866 | City of Galena | Clinic/Center | 148 Katido Street, Kaltag, AK 99748-0148 | 2008-07-16 |
| 1952422859 | Alaska Island Community Services | Clinic/Center | Naukati Community School, Naukati, AK 99950 | 2007-04-02 |
| 1699892307 | Sunshine Community Health Center Inc | Clinic/Center | 24091 W Long Lake Rd, Willow, AK 99688-9999 | 2007-03-26 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.