Organization
SOUTHCENTRAL FOUNDATION
Active
Parent organization
SOUTHCENTRAL FOUNDATION
Other names
Rural Health Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHCENTRAL FOUNDATION
Authorized official
RONALD LEE OLSON (VP FINANCE)
(907) 729-4939
Entity
Organization
Contact information
Practice address
10 DNR ROAD, MCGRATH, AK 99627
(907) 524-3299
Mailing address
4501 DIPLOMACY DR, ATTN: PROVIDER ENROLLMENT, ANCHORAGE, AK 99508-5919
(907) 729-4955
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20467
AK
Other
Enumeration date
04/11/2008
Last updated
02/04/2016
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