Organization
MANIILAQ ASSOCIATION
Active
Parent organization
MANIILAQ ASSOCIATION
Other names
Kobuk Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
MANIILAQ ASSOCIATION
Authorized official
GUS NELSON (PROVIDER ENROLLMENT SPECIALIST)
(907) 442-3321
Entity
Organization
Contact information
Practice address
51003 MAIN ST, KOBUK, AK 99751
(907) 442-3321
(907) 442-7250
Mailing address
PO BOX 43, KOTZEBUE, AK 99752-0043
(907) 442-3321
(907) 442-7250
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
02/24/2022
Last updated
03/15/2022
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