HSWL FO KODIAK DET KETCHIKAN


Address: 1300 Stedman St, Ketchikan, AK 99901-6661
Phone: 9072280320

HSWL FO KODIAK DET KETCHIKAN (NPI# 1285948877) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1285948877
Entity Type Organization
Organization Name HSWL FO KODIAK DET KETCHIKAN
Other Organization Name INTEGRATED SUPPORT COMMAND KETCHIKAN
Practice Address 1300 Stedman St
Ketchikan
AK 99901-6661
Practice Telephone 9072280320
Practice Fax Number 9072280255
Mailing Telephone 9072280320
Mailing Fax Number 9072280255
Enumeration Date 2010-08-06
Last Update Date 2010-08-06
Authorized Official Name ROBERT BIDWELL (CLINIC ADMINISTRATOR)
Authorized Official Telephone 9072280320
Is Organization Subpart Y
Parent Organization Name U.S. COAST GUARD

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 332000000X Military/U.S. Coast Guard Pharmacy Suppliers
Y 261QM1101X Clinic/Center
Specialization: Military and U.S. Coast Guard Ambulatory Procedure
Ambulatory Health Care Facilities

Other Provider/Organization Names

Other Name Type Code
Integrated Support Command Ketchikan Former Legal Business Name - Organization

Office Location

Street Address 1300 STEDMAN ST
City KETCHIKAN
State AK
Zip Code 99901-6661

Providers in the same location

NPI Name Taxonomy Address Enumeration
1508827163 Edward Bomberger II Technician, Other 1300 Stedman St, Ketchikan, AK 99901-6661 2006-03-31
1588015309 Billy J Stroud IIi Technician, Other 1300 Stedman St, Ketchikan, AK 99901-6661 2016-06-22
1942650387 Ashley Sarkisian Technician, Other 1300 Stedman St, Ketchikan, AK 99901-6661 2016-06-16
1215383377 William Jahns Technician, Other 1300 Stedman St, Ketchikan, AK 99901-6661 2016-05-09
1740624170 Angie Smitley Dental Hygienist 1300 Stedman St, Ketchikan, AK 99901-6661 2013-04-29
1275768426 Lindsay Sonnier Technician, Other 1300 Stedman St, Ketchikan, AK 99901-6661 2009-05-18
1912131608 Michael John Dellaneve Technician, Other 1300 Stedman St, Ketchikan, AK 99901-6661 2009-05-08
1619143658 U.S. Coast Guard Medical Clinic Case Management 1300 Stedman St, Ketchikan, AK 99901-6661 2008-04-30
1194900829 Rhett Jackson Registered Nurse 1300 Stedman St, Ketchikan, AK 99901-6661 2007-12-31
1346450905 John Gilbert Technician, Other 1300 Stedman St, Ketchikan, AK 99901-6661 2007-05-23
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Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 261QM1101X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Military and U.S. Coast Guard Ambulatory Procedure

Taxonomy Definition

That part of a "fixed" (non-temporary, non-deployed) DoD or Coast Guard entity furnishing surgical procedures requiring medically supervised recovery. Similar to a civilian ambulatory surgical center. May be in shared resources with a DoD or Coast Guard Clinic or a DoD Hospital. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport. Includes initial "take home" pharmaceuticals.
Notes: Source: TRICARE Management Activity Uniform Business Office User’s Guide [1/1/2005: title modified, definition added; 7/1/2006 title modified, definition modified]

Competitor

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City KETCHIKAN
Zip Code 99901

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Dataset Information

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.

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