# KETCHIKAN INDIAN CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** KIC Tribal Health Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821120486
- **Authorized official:** WENDY ROSS (RCM)
- **Authorized official phone:** (907) 228-9254

## Contact information

- **Practice address:** 2960 TONGASS AVE, BUSINESS OFFICE, KETCHIKAN, AK 99901-5742
- **Practice address phone:** (907) 228-9200
- **Practice address fax:** (800) 887-8796
- **Mailing address:** 2960 TONGASS AVE, BUSINESS OFFICE, KETCHIKAN, AK 99901-5742
- **Mailing address phone:** (907) 228-9200
- **Mailing address fax:** (800) 887-8796

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 183500000X | Pharmacist | 78545 | AK | — |
| 251S00000X | Community/Behavioral Health Agency | 78545 | AK | — |
| 261QD0000X | Dental Clinic/Center | 78545 | AK | — |
| 261QP2300X | Primary Care Clinic/Center | 78545 | AK | Yes |

## Other

- **Enumeration date:** 03/09/2007
- **Last updated:** 04/28/2021