KETCHIKAN INDIAN CORPORATION (NPI# 1821120486) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821120486 |
| Entity Type | Organization |
| Organization Name | KETCHIKAN INDIAN CORPORATION |
| Other Organization Name | KIC TRIBAL HEALTH CLINIC |
| Practice Address |
2960 Tongass Ave Business Office Ketchikan AK 99901-5742 |
| Practice Telephone | 9072289200 |
| Practice Fax Number | 8008878796 |
| Mailing Telephone | 9072289200 |
| Mailing Fax Number | 8008878796 |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2016-09-23 |
| Authorized Official Name | VERNA MCKELVY (BUSINESS OFFICE DIRECTOR) |
| Authorized Official Telephone | 9072289425 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QD0000X |
Clinic/Center Specialization: Dental |
78545 | AK | Ambulatory Health Care Facilities |
| N | 251S00000X | Community/Behavioral Health | 78545 | AK | Agencies |
| N | 183500000X | Pharmacist | 78545 | AK | Pharmacy Service Providers |
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
78545 | AK | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | CL2696 | 05 |
| Other Name | Type Code |
|---|---|
| KIC Tribal Health Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396153649 | Ketchikan Indian Corporation | Clinic/Center | 2960 Tongass Ave, Ketchikan, AK 99901-5742 | 2014-07-31 |
| 1205159571 | Ketchikan Indian Corporation | Clinic/Center | 2960 Tongass Ave, Ketchikan, AK 99901-5742 | 2010-03-01 |
| Street Address |
2960 TONGASS AVE BUSINESS OFFICE |
| 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 | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477029767 | Pacific Pediatrics, LLC | Clinic/Center | 3137 Tongass Ave # C, Ketchikan, AK 99901-5745 | 2018-10-15 |
| 1669956595 | Chelsea Youmans, Fnp LLC | Clinic/Center | 3528 Tongass Ave, Ketchikan, AK 99901-5635 | 2018-09-17 |
| 1417031618 | First City Medicine LLC | Clinic/Center | 212 Carlanna Lake Rd Ste 201, Box 6755, Ketchikan, AK 99901-5642 | 2006-10-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295361228 | Akins Mobile Health & Clinical Consultants, LLC | Clinic/Center | 2942 Gladys Marie Cir, Anchorage, AK 99516-1407 | 2020-03-22 |
| 1457865271 | Vera Whole Health Inc | Clinic/Center | 1450 Muldoon Rd, Anchorage, AK 99504-2820 | 2017-12-01 |
| 1902352206 | Lacuna Family Medicine, Inc. | Clinic/Center | 204 4th Ave, Seward, AK 99664 | 2016-08-28 |
| 1619333788 | Earthsong Integrative Medicine and Midwifery, LLC | Clinic/Center | 223 Gold St Uppr Unit, Juneau, AK 99801-1210 | 2016-01-05 |
| 1700272705 | John D. Zipperer Jr Md, LLC | Clinic/Center | 751 Old Richardson Hwy., Fairbanks, AK 99701 | 2015-04-07 |
| 1780079749 | John D. Zipperer Jr Md, LLC | Clinic/Center | 2110 E. Northern Lights Blvd., Suite 102, Anchorage, AK 99508 | 2015-04-06 |
| 1467874933 | Now Health, LLC | Clinic/Center | 625 Cobb Street, Suite 201, Palmer, AK 99645 | 2014-01-17 |
| 1972894418 | Kim Thiele, Do, PC | Clinic/Center | 105 Trading Bay Dr, Suite 105, Kenai, AK 99611-7717 | 2011-05-02 |
| 1609173798 | M. Jane Moore, Md. LLC. | Clinic/Center | 3260 Providence Dr Ste 526, Anchorage, AK 99508-4608 | 2011-02-25 |
| 1821304379 | Manuka Health Clinic, LLC | Clinic/Center | 3685 Arctic Blvd, Anchorage, AK 99503-5704 | 2010-08-23 |
| 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.