Organization
CREEKSIDE FAMILY HEALTH CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN HILL (OFFICE MANAGER)
(907) 220-9982
Entity
Organization
Contact information
Practice address
320 BAWDEN ST, SUITE #313, KETCHIKAN, AK 99901-6573
(907) 220-9982
(907) 220-9972
Mailing address
3521 LOMITA BLVD, SUITE #103, TORRANCE, CA 90505-5039
(310) 534-9131
(310) 534-9132
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MPG0359
—
AK
05
—
NP0504
—
AK
Enumeration date
05/31/2011
Last updated
11/13/2012
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