Basic Information
| Provider Information | |||||||||
| NPI: | 1851649305 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALASKA ISLAND COMMUNITY SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1231 | ||||||||
| Address2: | |||||||||
| City: | WRANGELL | ||||||||
| State: | AK | ||||||||
| PostalCode: | 999291231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9078742373 | ||||||||
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| Practice Location | |||||||||
| Address1: | 232 WOOD ST | ||||||||
| Address2: | |||||||||
| City: | WRANGELL | ||||||||
| State: | AK | ||||||||
| PostalCode: | 999291231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9078744700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2012 | ||||||||
| LastUpdateDate: | 08/15/2012 | ||||||||
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| AuthorizedOfficialLastName: | BUHLER | ||||||||
| AuthorizedOfficialFirstName: | GEORGIANNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9078745012 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC1500X | Y | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
No ID Information.