Basic Information
| Provider Information | |||||||||
| NPI: | 1518955731 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WRANGELL MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1081 | ||||||||
| Address2: | |||||||||
| City: | WRANGELL | ||||||||
| State: | AK | ||||||||
| PostalCode: | 999291081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9078747000 | ||||||||
| FaxNumber: | 9078747122 | ||||||||
| Practice Location | |||||||||
| Address1: | 310 BENNETT STREET | ||||||||
| Address2: | |||||||||
| City: | WRANGELL | ||||||||
| State: | AK | ||||||||
| PostalCode: | 999291081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9078747000 | ||||||||
| FaxNumber: | 9078747122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2005 | ||||||||
| LastUpdateDate: | 12/17/2015 | ||||||||
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| AuthorizedOfficialLastName: | SHYMANSKI | ||||||||
| AuthorizedOfficialFirstName: | ROSE | ||||||||
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| AuthorizedOfficialTitleorPosition: | ACCOUNTS RECEIVABLE COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 9078747000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | RPCH-003 | AK | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 1005585 | 05 | AK | MEDICAID | 1020479 | 05 | AK | MEDICAID | HS06LT | 05 | AK | MEDICAID | HS06OP | 05 | AK | MEDICAID | HS06SB | 05 | AK | MEDICAID | 1005584 | 05 | AK | MEDICAID | HS06IP | 05 | AK | MEDICAID | 127 | 01 | AK | BLUE CROSS | OTHER | MS5700 | 05 | AK | MEDICAID |