# SOUTHCENTRAL FOUNDATION

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SOUTHCENTRAL FOUNDATION
- **Other names:** Tribal- KKGB OB/GYN
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1124666730
- **Legal business name:** SOUTHCENTRAL FOUNDATION
- **Authorized official:** RONALD LEE OLSON (EXECUTIVE VICE PRESIDENT FINANCE)
- **Authorized official phone:** (907) 729-4939

## Contact information

- **Practice address:** 4441 DIPLOMACY DR, ANCHORAGE, AK 99508-5910
- **Practice address phone:** (907) 729-3100
- **Mailing address:** PO BOX 35198, SEATTLE, WA 98124-5198

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/13/2019
- **Last updated:** 08/31/2023