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Organization
KODIAK ISLAND AMBULATORY CARE CLINIC INC.
Active
Organization
KODIAK ISLAND AMBULATORY CARE CLINIC INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN M. KOLLER M.D. (PRESIDENT)
(907) 486-6188
Entity
Organization
Contact information
Practice address
202 CENTER AVE, STE. 102, KODIAK, AK 99615-1126
(907) 486-6188
(907) 486-6146
Mailing address
PO BOX 1126, KODIAK, AK 99615-1126
(907) 486-6188
(907) 486-6146
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
DL282350
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02D0985615
CLIA NUMBER
AK
01
—
6270850001
MEDICARE DME
—
01
—
DL282350
BUSINESS LICENSE NUMBER
AK
01
—
K162500
MEDICARE PTAN
—
05
—
MD10072
—
AK
Enumeration date
01/23/2007
Last updated
05/16/2011
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