Organization
SOUTHCENTRAL FOUNDATION
Active
Parent organization
SOUTHCENTRAL FOUNDATION
Other names
Tribal- Indian Creek Health 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
101 INDIAN CREEK ROAD, TYONEK, AK 99682
(907) 583-2461
Mailing address
PO BOX 35198, SEATTLE, WA 98124-5198
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
20467
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1643601
—
AK
Enumeration date
01/14/2016
Last updated
09/14/2023
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