KETCHIKAN INDIAN COMMUNITY HEALTH CLINIC (NPI# 1699983361) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699983361 |
| Entity Type | Organization |
| Organization Name | KETCHIKAN INDIAN COMMUNITY HEALTH CLINIC |
| Practice Address |
2960 Tongass Ave Ketchikan AK 99901-5742 |
| Practice Telephone | 9072250320 |
| Practice Fax Number | 9072474819 |
| Mailing Telephone | 9072250320 |
| Mailing Fax Number | 9072474819 |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | CHUCK ELLIOTT (DIRM) |
| Authorized Official Telephone | 9072285282 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332800000X | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NCPDP NUMBER | 0202325 | 01 | |
| PHARMACY DEA | BK6732083 | 01 | |
| AK | PH2696 | 05 |
| Street Address |
2960 TONGASS AVE |
| City | KETCHIKAN |
| State | AK |
| Zip Code | 99901-5742 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154315109 | Kathryn Lynn Price | Family Medicine | 2960 Tongass Ave, Ketchikan, AK 99901-5742 | 2005-09-06 |
| 1427668300 | Morgan Wayne Holmes | Dentist | 2960 Tongass Ave, Ketchikan, AK 99901-5742 | 2020-08-05 |
| 1073177424 | Maxx Ritchie Keizer | Pharmacist | 2960 Tongass Ave, Ketchikan, AK 99901-5742 | 2019-04-30 |
| 1043763824 | Ying Kwok | Dentist | 2960 Tongass Ave, Ketchikan, AK 99901-5742 | 2016-07-28 |
| 1780036491 | Andrea A. Lui | Family Medicine | 2960 Tongass Ave, Ketchikan, AK 99901-5742 | 2016-07-06 |
| 1912370347 | Pamela Lee Rogers | Nurse Practitioner | 2960 Tongass Ave, Ketchikan, AK 99901-5742 | 2015-11-06 |
| 1356745723 | Megan Hanifin | Counselor | 2960 Tongass Ave, Ketchikan, AK 99901-5742 | 2014-10-14 |
| 1396153649 | Ketchikan Indian Corporation | Clinic/Center | 2960 Tongass Ave, Ketchikan, AK 99901-5742 | 2014-07-31 |
| 1427460997 | Gerry Balluta | Case Manager/Care Coordinator | 2960 Tongass Ave, Ketchikan, AK 99901-5742 | 2014-06-02 |
| 1447670393 | Kristin Santroch | Dentist | 2960 Tongass Ave, Ketchikan, AK 99901 | 2014-04-18 |
| 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 | 332800000X |
| Grouping | Suppliers |
| Classification | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy |
| An Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy means a pharmacy operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization, all of which are defined in Section 4 of the Indian Health Care Improvement Act, 25 U.S.C. 1603. |
| Notes: Source: The Medicare Prescription Drug, Improvement and Modernization Act of 2003 [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720460652 | Alaska Native Tribal Health Consortium | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 3801 University Lake Dr Ste 100, Anchorage, AK 99508-4658 | 2015-06-27 |
| 1972869071 | Alaska Native Tribal Health Consortium | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 1w326, 4315 Diplomacy Drive, Anchorage, AK 99508 | 2012-04-03 |
| 1194848242 | Searhc Haines Medical Clinic Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 131 First Ave South, Haines, AK 99827-1549 | 2007-04-06 |
| 1366587743 | Scf Rasu Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 4160 Tudor Centre Dr, Anchorage, AK 99508-5901 | 2007-02-21 |
| 1154493666 | Maniilaq Health Center Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 5th St and Grizzley, Kotzebue, AK 99752 | 2006-11-14 |
| 1881780880 | Searhc - Mte Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 222 Tongass Drive, Sitka, AK 99835 | 2006-10-05 |
| 1851486153 | Searhc - Juneau Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 1200 Salmon Creek Road, Juneau, AK 99801 | 2006-10-03 |
| 1245605179 | Norton Sound Health Corporation | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 189 Airport Road, Unalakleet, AK 99684-0189 | 2015-12-03 |
| 1760739601 | Southcentral Foundation | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 1001 S Knik Goose Bay Rd, Wasilla, AK 99654-8083 | 2012-08-09 |
| 1811106271 | Alaska Native Tribal Health Consortium | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 4315 Diplomacy Dr, Anchorage, AK 99508-5926 | 2007-05-22 |
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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.