KETCHIKAN INDIAN CORPORATION (NPI# 1396153649) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396153649 |
| Entity Type | Organization |
| Organization Name | KETCHIKAN INDIAN CORPORATION |
| Other Organization Name | KIC TRIBAL HEALTH CLINIC |
| Practice Address |
2960 Tongass Ave Ketchikan AK 99901-5742 |
| Practice Telephone | 9072289200 |
| Practice Fax Number | 8008878796 |
| Mailing Telephone | 9072289200 |
| Mailing Fax Number | 8008878796 |
| Enumeration Date | 2014-07-31 |
| Last Update Date | 2014-07-31 |
| Authorized Official Name | MR. STEVE F HUDSON (HEALTH ADMINISTRATOR) |
| Authorized Official Telephone | 9072289253 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
378 | AK | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | BUSINESS PROFESSIONAL LICENSE | 378 | 01 |
| Other Name | Type Code |
|---|---|
| KIC TRIBAL HEALTH CLINIC | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205159571 | Ketchikan Indian Corporation | Clinic/Center | 2960 Tongass Ave, Ketchikan, AK 99901-5742 | 2010-03-01 |
| 1821120486 | Ketchikan Indian Corporation | Clinic/Center | 2960 Tongass Ave, Business Office, Ketchikan, AK 99901-5742 | 2007-03-09 |
| 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 |
| 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 |
| 1477989804 | Charles David Valadez Jr. | Psychologist | 2960 Tongass Ave, Ketchikan, AK 99901-5742 | 2013-09-17 |
| 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 | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821120486 | Ketchikan Indian Corporation | Clinic/Center | 2960 Tongass Ave, Business Office, Ketchikan, AK 99901-5742 | 2007-03-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962011593 | Deyoung Dentistry, LLC | Clinic/Center | 2601 Boniface Parkway Suite 1, Anchorage, AK 99504 | 2020-07-29 |
| 1205461084 | Hawkinson Dental Inc | Clinic/Center | 6200 Lake Otis Pkwy Ste 101, Anchorage, AK 99507-2098 | 2020-03-11 |
| 1982238622 | Donald R Mclean | Clinic/Center | 3719 E Meridian Loop Ste B, Wasilla, AK 99654-7273 | 2020-03-02 |
| 1740745439 | Susan Olson Dmd Inc | Clinic/Center | 3261 S. Big Lake Rd. Ste D3-d4, Big Lake, AK 99652 | 2019-02-06 |
| 1932664877 | Alaska Family Dental LLC | Clinic/Center | 405 W 36th Ave Ste 101, Anchorage, AK 99503-5872 | 2019-02-05 |
| 1174016737 | Lake Road Dental LLC | Clinic/Center | 4622 Shannon Lake Rd, Dillingham, AK 99576 | 2018-06-08 |
| 1659862134 | Evelyn Haley Dmd | Clinic/Center | 615 E 82nd Ave Ste 100, Anchorage, AK 99518-3100 | 2018-05-21 |
| 1891285433 | Alaskan Family Dental Center LLC | Clinic/Center | 281 N Main St Ste 201, Wasilla, AK 99654-7046 | 2018-05-17 |
| 1376051797 | Caroline Curtis Dmd PC | Clinic/Center | 16635 Centerfield Dr Ste 207, Eagle River, AK 99577-7746 | 2018-01-19 |
| 1417475716 | Michael G. Crookston Dds PC | Clinic/Center | 11723 Old Glenn Hwy Ste 207, Eagle River, AK 99577-7750 | 2017-09-07 |
| 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.