Basic Information
| Provider Information | |||||||||
| NPI: | 1205255957 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FRONT STREET HEALTH CENTER | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | FRONT STREET COMMUNITY HEALTH CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 225 FRONT ST STE 202 | ||||||||
| Address2: | |||||||||
| City: | JUNEAU | ||||||||
| State: | AK | ||||||||
| PostalCode: | 998011244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074634201 | ||||||||
| FaxNumber: | 9074636617 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 FRONT ST STE 202 | ||||||||
| Address2: | |||||||||
| City: | JUNEAU | ||||||||
| State: | AK | ||||||||
| PostalCode: | 998011244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074634201 | ||||||||
| FaxNumber: | 9074636617 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2014 | ||||||||
| LastUpdateDate: | 04/09/2014 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BREWSTER | ||||||||
| AuthorizedOfficialFirstName: | JANNA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL PROVIDER/EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9074634201 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | ANP | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC1500X | Y | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
No ID Information.