# SOUTHCENTRAL FOUNDATION

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SOUTHCENTRAL FOUNDATION
- **Other names:** Rural Health Clinic
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1366615114
- **Legal business name:** SOUTHCENTRAL FOUNDATION
- **Authorized official:** RONALD LEE OLSON (VP FINANCE)
- **Authorized official phone:** (907) 729-4939

## Contact information

- **Practice address:** 10 DNR ROAD, MCGRATH, AK 99627
- **Practice address phone:** (907) 524-3299
- **Mailing address:** 4501 DIPLOMACY DR, ATTN: PROVIDER ENROLLMENT, ANCHORAGE, AK 99508-5919
- **Mailing address phone:** (907) 729-4955

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 20467 | AK | Yes |

## Other

- **Enumeration date:** 04/11/2008
- **Last updated:** 02/04/2016