Organization
SOUTHCENTRAL FOUNDATION
Active
Parent organization
SOUTHCENTRAL FOUNDATION
Other names
Tribal/HPG- Valley Native Primary Care Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHCENTRAL FOUNDATION
Authorized official
RONALD LEE OLSON (EXECUTIVE VICE PRESIDENT FINANCE)
(907) 729-4939
Entity
Organization
Contact information
Practice address
1001 S KNIK GOOSE BAY RD, WASILLA, AK 99654-8083
(907) 631-7800
Mailing address
PO BOX 35198, SEATTLE, WA 98124-5198
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
20467
AK
261QP2300X
Primary Care Clinic/Center
20467
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000873
—
AK
05
—
1020925
—
AK
Enumeration date
06/21/2006
Last updated
09/01/2023
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