KIC TRIBAL HEALTH CLINIC (NPI# 1043533946) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043533946 |
| Entity Type | Organization |
| Organization Name | KIC TRIBAL HEALTH CLINIC |
| Practice Address |
2960 Tongass Ave Ketchikan AK 99901-5742 |
| Practice Telephone | 9072284900 |
| Practice Fax Number | 9072284905 |
| Mailing Telephone | 9072284900 |
| Mailing Fax Number | 9072284905 |
| Enumeration Date | 2010-03-05 |
| Last Update Date | 2010-03-05 |
| Authorized Official Name | MS. MARSHA M RAMIREZ (DIABETES COORDINATOR) |
| Authorized Official Telephone | 9072284900 |
| Authorized Official Credential | CNA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
10728 | AK | Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124341896 | Kic Tribal Health Clinic | Clinic/Center | 2960 Tongass Ave, Ketchikan, AK 99901-5742 | 2010-03-09 |
| 1437471844 | Kic Tribal Health Clinic | Clinic/Center | 2960 Tongass Ave, Ketchikan, AK 99901-5742 | 2010-02-26 |
| 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 | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821511064 | Cross Road Health Ministries, Inc. | Clinic/Center | 187 Glenn Highway, Glennallen, AK 99588-0589 | 2017-07-19 |
| 1568902583 | Sunshine Community Health Center, Inc | Clinic/Center | 42728 S Parks Highway, Talkeetna, AK 99676 | 2017-02-24 |
| 1467991455 | Sunshine Community Health Center, Inc | Clinic/Center | 13930 E Timberwolf Loop, Talkeetna, AK 99676 | 2017-02-23 |
| 1477003978 | Alaska Island Community Services | Clinic/Center | 110 Lynch Street, Wrangell, AK 99929 | 2016-10-07 |
| 1679718019 | Camai Community Health Center, Inc. | Clinic/Center | # 2 School Rd, Naknek, AK 99633-0211 | 2008-12-15 |
| 1487818639 | City of Galena | Clinic/Center | 74 Ruby Road, Ruby, AK 99768-0074 | 2008-07-17 |
| 1568626760 | City of Galena | Clinic/Center | 30 Koyukuk Lane, Koyukuk, AK 99754-0030 | 2008-07-16 |
| 1669636866 | City of Galena | Clinic/Center | 148 Katido Street, Kaltag, AK 99748-0148 | 2008-07-16 |
| 1952422859 | Alaska Island Community Services | Clinic/Center | Naukati Community School, Naukati, AK 99950 | 2007-04-02 |
| 1699892307 | Sunshine Community Health Center Inc | Clinic/Center | 24091 W Long Lake Rd, Willow, AK 99688-9999 | 2007-03-26 |
| 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.