Organization
INTERIOR COMMUNITY HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL KILGORE (EXECUTIVE DIRECTOR)
(907) 455-4567
Entity
Organization
Contact information
Practice address
1606 23RD AVE, FAIRBANKS, AK 99701-6407
(907) 455-4567
(907) 458-1589
Mailing address
1606 23RD AVE, FAIRBANKS, AK 99701-6407
(907) 455-4567
(907) 458-1589
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02D0876889
CLIA
—
01
—
02D0902300
CLIA
AK
Enumeration date
05/31/2007
Last updated
08/04/2008
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