SOUTHCENTRAL FOUNDATION (NPI# 1760739601) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760739601 |
| Entity Type | Organization |
| Organization Name | SOUTHCENTRAL FOUNDATION |
| Practice Address |
1001 S Knik Goose Bay Rd Wasilla AK 99654-8083 |
| Practice Telephone | 9076317800 |
| Practice Fax Number | 9076317619 |
| Mailing Telephone | 9076317800 |
| Mailing Fax Number | 9076317619 |
| Enumeration Date | 2012-08-09 |
| Last Update Date | 2014-08-21 |
| 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 | 332800000X | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 20467 | AK | Suppliers |
| 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 |
1001 S KNIK GOOSE BAY RD |
| City | WASILLA |
| State | AK |
| Zip Code | 99654-8083 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245285964 | Laurie Elizabeth Dahms | Family Medicine | 1001 S Knik Goose Bay Rd, Wasilla, AK 99654-8083 | 2006-05-23 |
| 1154947570 | Heather Hamilton | Advanced Practice Midwife | 1001 S Knik Goose Bay Rd, Wasilla, AK 99654-8083 | 2020-06-22 |
| 1356964662 | Allison Michelle Hillen | Dietitian, Registered | 1001 S Knik Goose Bay Rd, Wasilla, AK 99654-8083 | 2020-05-20 |
| 1619526381 | Emily K Wood | Counselor | 1001 S Knik Goose Bay Rd, Wasilla, AK 99654-8083 | 2019-09-05 |
| 1114573284 | Emily Marie Schmitt | Nurse Practitioner | 1001 S Knik Goose Bay Rd, Wasilla, AK 99654-8083 | 2019-08-14 |
| 1225683709 | Jolie Miller | Registered Nurse | 1001 S Knik Goose Bay Rd, Wasilla, AK 99654-8083 | 2019-08-01 |
| 1003469719 | Southcentral Foundation | Community/Behavioral Health | 1001 S Knik Goose Bay Rd, Wasilla, AK 99654-8083 | 2019-07-22 |
| 1497317168 | Tarah Ruth Desatoff | Optometrist | 1001 S Knik Goose Bay Rd, Wasilla, AK 99654-8083 | 2019-07-02 |
| 1417518143 | Holli Blake | Social Worker | 1001 S Knik Goose Bay Rd, Wasilla, AK 99654-8083 | 2019-06-24 |
| 1831755560 | Kathy Bowman | Case Manager/Care Coordinator | 1001 S Knik Goose Bay Rd, Wasilla, AK 99654-8083 | 2019-05-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003426784 | Colleen Maggie Newcity | Case Manager/Care Coordinator | 851 Westpoint Suite 310, Wasilla, AK 99654 | 2020-08-06 |
| 1659995884 | Amy M Lowe | Peer Specialist | 1363 W Spuce Ave, Wasilla, AK 99654 | 2020-06-03 |
| 1922648690 | Achieve Medical Alaska LLC | Clinic/Center | 1981 E Palmer, Suite 230, Wasilla, AK 99654 | 2020-01-10 |
| 1588205538 | Juan Carlos Garcia | Physician Assistant | 950 East Bogard Road, Suite 103, Wasilla, AK 99654 | 2019-10-01 |
| 1427610864 | Sharon Webb | Counselor | 705 S Knik Goose Bay Rd Suite K, Wasilla, AK 99654 | 2019-07-06 |
| 1306401864 | Logan Lee Cook | Peer Specialist | 2953 E Fairview Loop, Wasilla, AK 99654 | 2019-05-09 |
| 1053883595 | Moose Creek Medical Clinic LLC | Nurse Practitioner | 2341 S. Fern St., Suite 300, Wasilla, AK 99654 | 2018-12-21 |
| 1487124962 | Melissa A Stevens | Massage Therapist | 2201 W That Rd, Wasilla, AK 99654 | 2018-11-28 |
| 1609359561 | Audrey E Beers | Midwife | 2405 S. Knik Goose Bay Rd., Wasilla, AK 99654 | 2018-09-07 |
| 1093297418 | Karlee Janine Mccorry | Occupational Therapist | 613 S Knik-goose Bay Rd, Wasilla, AK 99654 | 2018-09-01 |
| Find all providers in zip 99654 | ||||
| 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 |
| 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 |
| 1699983361 | Ketchikan Indian Community Health Clinic | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 2960 Tongass Ave, Ketchikan, AK 99901-5742 | 2007-05-18 |
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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.