SOUTHCENTRAL FOUNDATION (NPI# 1699393132) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699393132 |
| Entity Type | Organization |
| Organization Name | SOUTHCENTRAL FOUNDATION |
| Practice Address |
4315 Diplomacy Dr Anchorage AK 99508-5926 |
| Mailing Address |
Po Box 35151 Seattle WA 98124-5151 |
| Practice Telephone | 9077290000 |
| Practice Fax Number | 2062999583 |
| Mailing Telephone | 9073176070 |
| Enumeration Date | 2020-07-10 |
| Last Update Date | 2020-07-10 |
| Authorized Official Name | KATHRYN SUZANNE MILLER (PATIENT ACCOUNTS MANAGER- DENTAL) |
| Authorized Official Telephone | 9073176070 |
| Authorized Official Credential | CPC, CDC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
Dental Providers | ||
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | 1616111 | 05 |
| Other Name | Type Code |
|---|---|
| Southcentral Foundation Dental ANMC OR | 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 |
4315 DIPLOMACY DR |
| City | ANCHORAGE |
| State | AK |
| Zip Code | 99508-5926 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972509669 | Steven James Denson | Chiropractor | 4315 Diplomacy Dr, Anchorage, AK 99508-5926 | 2005-06-27 |
| 1982202156 | Christina Eldridge | Pharmacist | 4315 Diplomacy Dr, Anchorage, AK 99508-5926 | 2020-10-11 |
| 1699304725 | Meghan Ballard | Occupational Therapist | 4315 Diplomacy Dr, Anchorage, AK 99508-5926 | 2020-04-01 |
| 1922633650 | Laura Cantrell | Student in an Organized Health Care Education/Training Program | 4315 Diplomacy Dr, Anchorage, AK 99508-5926 | 2020-03-03 |
| 1609416064 | Matthew Wade | Nurse Anesthetist, Certified Registered | 4315 Diplomacy Dr, Anchorage, AK 99508-5926 | 2020-01-13 |
| 1407494677 | Michael Bruce | Preventive Medicine | 4315 Diplomacy Dr, Anchorage, AK 99508-5926 | 2019-12-18 |
| 1336787993 | Korin Scott | Occupational Therapist | 4315 Diplomacy Dr, Anchorage, AK 99508-5926 | 2019-12-13 |
| 1215578422 | Andrew James Baker | Registered Nurse | 4315 Diplomacy Dr, Anchorage, AK 99508-5926 | 2019-09-30 |
| 1861042749 | Anthony Martin | Physical Therapist | 4315 Diplomacy Dr, Anchorage, AK 99508-5926 | 2019-09-12 |
| 1518519644 | Nancy Colleen Hukka | Occupational Therapist | 4315 Diplomacy Dr, Anchorage, AK 99508-5926 | 2019-07-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366063349 | Alexandra L Davis | Student in an Organized Health Care Education/Training Program | 1202 E 36th Ave, Anchorage, AK 99508 | 2020-05-01 |
| 1366087108 | The Salvation Army, A California Corporation | Community/Behavioral Health | 3600 East 20th Avenue, Anchorage, AK 99508 | 2019-11-15 |
| 1679120349 | Kila Gilcart | Speech-Language Pathologist | 161 Klevin Street #103, Anchorage, AK 99508 | 2019-08-19 |
| 1326692963 | Shannon Maillet | Behavior Technician | 1650 S Bragaw, Anchorage, AK 99508 | 2019-07-31 |
| 1427602044 | Frank Harris Lawson Iv | Behavior Technician | 1650 S. Bragaw, Anchorage, AK 99508 | 2019-07-31 |
| 1104470723 | Vivalesi Seforosa Nair | Behavior Technician | 1650 South Bragaw, Anchorage, AK 99508 | 2019-07-31 |
| 1043864267 | The Cozy Chalet Assisted Living Home LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3707 Mt Blanc Circle, Anchorage, AK 99508 | 2019-07-25 |
| 1942861778 | Christine Mary Hoover | Registered Nurse | Alaska Native Medical Center - Inpatient Pediatrics, 4315 Diplomacy Dr, Anchorage, AK 99508 | 2019-06-24 |
| 1215594502 | Ashley Ongtowasruk | Case Manager/Care Coordinator | 4441 Dipomacy Dr, Suite 500, Anchorage, AK 99508 | 2019-05-22 |
| 1659937019 | Rayne Johnson | Behavior Technician | 4000 San Ernesto Blvd, Anchorage, AK 99508 | 2019-05-11 |
| Find all providers in zip 99508 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215446042 | Frontier Oral & Maxillofacial Surgery LLC | Dentist | 3220 Providence Dr Ste E3-080, Anchorage, AK 99508-4657 | 2017-09-25 |
| 1063710994 | Fairbanks Oral Surgery, LLC | Dentist | 12810 Glen Alps Rd, Anchorage, AK 99516-6956 | 2011-03-01 |
| 1760619118 | Bradley John Szutz | Dentist | 1200 Airport Heights Dr. Suite #265, Anchorage, AK 99508 | 2009-06-12 |
| 1689810707 | Alaska Oral Surgery Group, P.C. | Dentist | 1200 Airport Heights Dr Ste 265, Anchorage, AK 99508-2988 | 2008-12-18 |
| 1194745570 | David M. Edwards | Dentist | 3330 Windlass Cir, Anchorage, AK 99516-3438 | 2006-07-20 |
| 1225058977 | Ray A. Holloway | Dentist | 111 W 16th Ave, Suite 203, Anchorage, AK 99501-6206 | 2006-07-19 |
| 1205869245 | Frederick Karl Reinbold | Dentist | 2000 Abbott Rd Ste 200, Anchorage, AK 99507-3867 | 2006-07-09 |
| 1679506638 | John Louis Drager | Dentist | 800 E. Dimond Ste 3-535, Anchorage, AK 99515 | 2006-07-09 |
| 1841747250 | Chugach Oral and Maxillofacial Surgery | Dentist | 2000 Abbott Rd, Ste 200, Anchorage, AK 99507-3878 | 2016-09-01 |
| 1184044752 | Elizabeth Consky | Dentist | 4315 Diplomacy Dr, Anchorage, AK 99508-5926 | 2014-04-22 |
| Find all providers in ANCHORAGE | ||||
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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.