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Organization

MANIILAQ ASSOCIATION

Active
Parent organization
MANIILAQ ASSOCIATION
Other names
Kivalina 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
8 BERING ST, KIVALINA, AK 99750
(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
261QD0000X
Dental Clinic/Center

Other

Enumeration date
02/24/2022
Last updated
03/15/2022
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