SOUTHCENTRAL FOUNDATION (NPI# 1609232040) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609232040 |
| Entity Type | Organization |
| Organization Name | SOUTHCENTRAL FOUNDATION |
| Other Organization Name | INDIAN CREEK HEALTH CENTER |
| Practice Address |
101 Indian Creek Road Tyonek AK 99682 |
| Mailing Address |
4501 Diplomacy Dr Attn: Finance/provider Enrollment Anchorage AK 99508-5919 |
| Practice Telephone | 9075832461 |
| Mailing Telephone | 9077294955 |
| Enumeration Date | 2016-01-14 |
| Last Update Date | 2016-01-14 |
| Authorized Official Name | RONALD LEE OLSON (VP FINANCE) |
| Authorized Official Telephone | 9077294939 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QC1500X |
Clinic/Center Specialization: Community Health |
20467 | AK | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Indian Creek Health Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407466204 | Southcentral Foundation | Clinic/Center | 11495 N Callison St, Sutton, AK 99674 | 2020-08-06 |
| 1528600947 | Southcentral Foundation | Clinic/Center | 6901 E Tudor Rd Ste 8, Anchorage, AK 99507-1254 | 2019-10-17 |
| 1639722069 | Southcentral Foundation | Community/Behavioral Health | 4175 Tudor Centre Dr, Anchorage, AK 99508-5917 | 2019-07-24 |
| 1659924025 | Southcentral Foundation | Community/Behavioral Health | 4341 Tudor Centre Dr Ste 300, Anchorage, AK 99508-5904 | 2019-07-24 |
| 1720548035 | Southcentral Foundation | Clinic/Center | 4441 Diplomacy Dr Fl 5, Anchorage, AK 99508-5910 | 2019-03-22 |
| 1750854089 | Southcentral Foundation | Clinic/Center | 400 W Benson Blvd, Anchorage, AK 99503-3829 | 2019-01-09 |
| 1639652662 | Southcentral Foundation | Clinic/Center | 26341 Eklutna Village Rd, Chugiak, AK 99567-5148 | 2018-09-14 |
| 1811420391 | Southcentral Foundation | Clinic/Center | 1021 E 3rd Ave, Anchorage, AK 99501-6102 | 2017-04-11 |
| 1043767940 | Southcentral Foundation | Dentist | 11495 N. Callison Street, Sutton, AK 99674 | 2016-09-08 |
| 1689021776 | Southcentral Foundation | Clinic/Center | 755 A St, Anchorage, AK 99501-3625 | 2016-05-18 |
| Street Address |
101 INDIAN CREEK ROAD |
| City | TYONEK |
| State | AK |
| Zip Code | 99682 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205368339 | Kimberly Shayd Ulery | Community Health Worker | 101 Indian Creek Road, Box 82068, Tyonek, AK 99682-0068 | 2017-03-29 |
| 1659828556 | Southcentral Foundation | Dentist | 101 Indian Creek Road, Tyonek, AK 99682 | 2016-09-08 |
| 1548628555 | Southcentral Foundation | Clinic/Center | 101 Indian Creek Road, Tyonek, AK 99682 | 2016-02-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407217268 | Chrystal Marie Moon | Community Health Worker | 100 Pumphouse Road, Tyonek, AK 99682 | 2016-03-08 |
| 1689925463 | Native Village of Tyonek | Clinic/Center | 73 C Street, Tyonek, AK 99682 | 2012-09-20 |
| 1245877711 | Frankie Christine Standifer | Community Health Worker | 101 Indian Creek Road 82068, Tyonek, AK 99682-0068 | 2019-12-04 |
| Taxonomy Code | 261QC1500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Community Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639652662 | Southcentral Foundation | Clinic/Center | 26341 Eklutna Village Rd, Chugiak, AK 99567-5148 | 2018-09-14 |
| 1881047108 | Aleutian Pribilof Islands Association | Clinic/Center | 111 Lakeview Rd., Nikolski, AK 99638 | 2016-07-21 |
| 1235595562 | Chitina Traditional Indian Village Council | Clinic/Center | Mile 28.5 Edgerton Hwy, Chitina, AK 99566 | 2015-12-31 |
| 1770953903 | Southcentral Foundation | Clinic/Center | 1 Flight Line Rd, Port Alsworth, AK 99653-9801 | 2015-09-30 |
| 1144699216 | Southcentral Foundation | Clinic/Center | 4030 Salmon Way, Iguigig, AK 99613 | 2015-09-18 |
| 1295104644 | Southcentral Foundation | Clinic/Center | 102 Fireweed Lane, Newhalen, AK 99606 | 2015-09-16 |
| 1952770307 | Southcentral Foundation | Clinic/Center | 2516 Mountain Circle, Pedro Bay, AK 99647 | 2015-09-16 |
| 1205255957 | Front Street Health Center | Clinic/Center | 225 Front St Ste 202, Juneau, AK 99801-1244 | 2014-04-09 |
| 1043632037 | Southcentral Foundation | Clinic/Center | 11495 N Callison Street, Sutton, AK 99674 | 2014-01-10 |
| 1851649305 | Alaska Island Community Services | Clinic/Center | 232 Wood St, Wrangell, AK 99929-1231 | 2012-08-15 |
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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.