HSWL FO KODIAK DET KETCHIKAN (NPI# 1285948877) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285948877 |
| Entity Type | Organization |
| Organization Name | HSWL FO KODIAK DET KETCHIKAN |
| Other Organization Name | INTEGRATED SUPPORT COMMAND KETCHIKAN |
| Practice Address |
1300 Stedman St Ketchikan AK 99901-6661 |
| Practice Telephone | 9072280320 |
| Practice Fax Number | 9072280255 |
| Mailing Telephone | 9072280320 |
| Mailing Fax Number | 9072280255 |
| Enumeration Date | 2010-08-06 |
| Last Update Date | 2010-08-06 |
| Authorized Official Name | ROBERT BIDWELL (CLINIC ADMINISTRATOR) |
| Authorized Official Telephone | 9072280320 |
| Is Organization Subpart | Y |
| Parent Organization Name | U.S. COAST GUARD |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332000000X | Military/U.S. Coast Guard Pharmacy | Suppliers | ||
| Y | 261QM1101X |
Clinic/Center Specialization: Military and U.S. Coast Guard Ambulatory Procedure |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Integrated Support Command Ketchikan | Former Legal Business Name - Organization |
| Street Address |
1300 STEDMAN ST |
| City | KETCHIKAN |
| State | AK |
| Zip Code | 99901-6661 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508827163 | Edward Bomberger II | Technician, Other | 1300 Stedman St, Ketchikan, AK 99901-6661 | 2006-03-31 |
| 1588015309 | Billy J Stroud IIi | Technician, Other | 1300 Stedman St, Ketchikan, AK 99901-6661 | 2016-06-22 |
| 1942650387 | Ashley Sarkisian | Technician, Other | 1300 Stedman St, Ketchikan, AK 99901-6661 | 2016-06-16 |
| 1215383377 | William Jahns | Technician, Other | 1300 Stedman St, Ketchikan, AK 99901-6661 | 2016-05-09 |
| 1740624170 | Angie Smitley | Dental Hygienist | 1300 Stedman St, Ketchikan, AK 99901-6661 | 2013-04-29 |
| 1275768426 | Lindsay Sonnier | Technician, Other | 1300 Stedman St, Ketchikan, AK 99901-6661 | 2009-05-18 |
| 1912131608 | Michael John Dellaneve | Technician, Other | 1300 Stedman St, Ketchikan, AK 99901-6661 | 2009-05-08 |
| 1619143658 | U.S. Coast Guard Medical Clinic | Case Management | 1300 Stedman St, Ketchikan, AK 99901-6661 | 2008-04-30 |
| 1194900829 | Rhett Jackson | Registered Nurse | 1300 Stedman St, Ketchikan, AK 99901-6661 | 2007-12-31 |
| 1346450905 | John Gilbert | Technician, Other | 1300 Stedman St, Ketchikan, AK 99901-6661 | 2007-05-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992314215 | Residential Youth Care, Inc. | Community/Behavioral Health | 2442 Tongass Avenue, Ketchikan, AK 99901 | 2020-07-23 |
| 1316563026 | Residential Youth Care, Inc. | Community/Behavioral Health | 606 Hill Road, Ketchikan, AK 99901 | 2020-06-18 |
| 1043836851 | Residential Youth Care, Inc. | Community/Behavioral Health | 2514 1st Avenue, Ketchikan, AK 99901 | 2020-06-18 |
| 1215553029 | Residential Youth Care, Inc. | Community/Behavioral Health | 2951 Baranof Avenue, Ketchikan, AK 99901 | 2020-06-18 |
| 1174159222 | Helene Rae Simpson | Behavior Technician | 201 Deermont St, Ketchikan, AK 99901 | 2020-03-20 |
| 1003295155 | Suzanne Webb | Massage Therapist | 602 Dock St Ste 106, Ketchikan, AK 99901 | 2015-05-22 |
| 1093194342 | Kate Mortensen | Case Manager/Care Coordinator | 2690 Tongass Ave, Ketchikan, AK 99901 | 2015-05-20 |
| 1578879631 | Thomas Peter Ryan | Social Worker | 320 Bawden St. #318, Ketchikan, AK 99901 | 2010-08-27 |
| 1689820979 | Akeela Inc | Community Based Residential Treatment Facility, Mental Illness | 3050 Fifth Ave, Ketchikan, AK 99901 | 2008-08-18 |
| 1750565438 | Susan Marie Swift | Nurse Practitioner | 21 Jefferson Way, Suite 202, Psychiatry, Ketchikan, AK 99901 | 2007-12-18 |
| Find all providers in zip 99901 | ||||
| Taxonomy Code | 261QM1101X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Military and U.S. Coast Guard Ambulatory Procedure |
| That part of a "fixed" (non-temporary, non-deployed) DoD or Coast Guard entity furnishing surgical procedures requiring medically supervised recovery. Similar to a civilian ambulatory surgical center. May be in shared resources with a DoD or Coast Guard Clinic or a DoD Hospital. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport. Includes initial "take home" pharmaceuticals. |
| Notes: Source: TRICARE Management Activity Uniform Business Office User’s Guide [1/1/2005: title modified, definition added; 7/1/2006 title modified, definition modified] |
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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.