Basic Information
| Provider Information | |||||||||
| NPI: | 1154452878 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SITKA MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 KATLIAN ST | ||||||||
| Address2: | SUITE E | ||||||||
| City: | SITKA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 998357359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077475861 | ||||||||
| FaxNumber: | 9077475415 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 KATLIAN ST STE E | ||||||||
| Address2: | |||||||||
| City: | SITKA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 998357359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077475861 | ||||||||
| FaxNumber: | 9077475415 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 08/25/2015 | ||||||||
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| AuthorizedOfficialLastName: | HUNTER | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 9077475861 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 118937 | AK | N | Suppliers | Durable Medical Equipment & Medical Supplies | 103TC0700X | 483 | AK | N | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical | 261QP2300X | 118937 | AK | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | 1004397 | 05 | AK | MEDICAID |