SOUTHCENTRAL FOUNDATION (NPI# 1912954272) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912954272 |
| Entity Type | Organization |
| Organization Name | SOUTHCENTRAL FOUNDATION |
| Other Organization Name | NILAVENA CLINIC |
| Practice Address |
101 Airport Road Iliamna AK 99606 |
| Mailing Address |
4501 Diplomacy Dr Attn: Provider Enrollment Anchorage AK 99508-5919 |
| Practice Telephone | 9075711818 |
| Mailing Telephone | 9077298624 |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2014-04-04 |
| Authorized Official Name | RONALD L. OLSON (VP OF FINANCE) |
| Authorized Official Telephone | 9077294939 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
20467 | AK | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Nilavena Clinic | 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 AIRPORT ROAD |
| City | ILIAMNA |
| State | AK |
| Zip Code | 99606 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396292298 | Southcentral Foundation | Dentist | 101 Airport Road, Iliamna, AK 99606 | 2016-09-08 |
| 1952417792 | Suzanne Margaret Milette | Physician Assistant | 101 Airport Road, Iliamna, AK 99606-9800 | 2006-08-22 |
| 1952318735 | Anne Elizabeth Dailey | Physician Assistant | 101 Airport Road, Iliamna, AK 99606-9800 | 2006-08-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679948848 | Kyle Aguiar | Community Health Worker | 1 Airport Rd., Kokhanok, AK 99606 | 2015-12-14 |
| 1295104644 | Southcentral Foundation | Clinic/Center | 102 Fireweed Lane, Newhalen, AK 99606 | 2015-09-16 |
| 1528528361 | Nicholas Mike | Nurse's Aide | 1008 Airport Rd, Kokhanok, AK 99606 | 2019-03-20 |
| 1578010476 | Southcentral Foundation | Dentist | 102 Fireweed Lane, Newhalen, AK 99606 | 2016-09-08 |
| 1497202394 | Southcentral Foundation | Dentist | 1008 Main Street, Kokhanok, AK 99606 | 2016-09-08 |
| 1609235738 | Southcentral Foundation | Clinic/Center | 1008 Main Street, Kokhanok, AK 99606 | 2016-02-17 |
| 1043689169 | Southcentral Foundation | Clinic/Center | 1008 Main Street, Kokhanok, AK 99606 | 2015-09-18 |
| 1356698161 | Francine Sophie Andrew | Counselor | 1047 Airport Road, Kokhanok, AK 99606-1047 | 2012-08-10 |
| 1194815126 | Ruth Singleton Alvarez | Physician Assistant | 101 Airport Rd., Iliamna, AK 99606-9800 | 2006-10-13 |
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487265690 | Whole Family Integrated Wellness LLC | Clinic/Center | 600 E 36th Ave Ste 300, Anchorage, AK 99503-4168 | 2020-08-11 |
| 1528600947 | Southcentral Foundation | Clinic/Center | 6901 E Tudor Rd Ste 8, Anchorage, AK 99507-1254 | 2019-10-17 |
| 1063980118 | Tanana Valley Clinic LLC | Clinic/Center | 1101 Noble St, Fairbanks, AK 99701-4924 | 2018-11-07 |
| 1558899807 | Arctic Chiropractic and Physical Medicine Kodiak | Clinic/Center | 2975 Mill Bay Rd Ste A, Kodiak, AK 99615-7831 | 2017-05-31 |
| 1811420391 | Southcentral Foundation | Clinic/Center | 1021 E 3rd Ave, Anchorage, AK 99501-6102 | 2017-04-11 |
| 1942751631 | Fairbanks Memorial Cardiology Clinic, LLC | Clinic/Center | 1650 Cowles St Dept 61a, Fairbanks, AK 99701-5907 | 2016-10-18 |
| 1689021776 | Southcentral Foundation | Clinic/Center | 755 A St, Anchorage, AK 99501-3625 | 2016-05-18 |
| 1194152058 | Peninsula Pediatric Therapy, Inc. | Clinic/Center | 7335 Palmer Wasilla Hwy, Palmer, AK 99645-6007 | 2013-10-08 |
| 1154591451 | La Integrative Primary Care Centre Inc | Clinic/Center | 8811 Toloff St, Anchorage, AK 99507-3848 | 2008-03-03 |
| 1962572099 | Juneau Family Birth Center | Clinic/Center | 3225 Hospital Dr Unit 106, Juneau, AK 99801-7863 | 2006-11-08 |
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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.