Organization
INDEPENDENCE HEALTHCARE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HENRY G KRULL MD (PRESIDENT)
(907) 262-6454
Entity
Organization
Contact information
Practice address
289 N FIREWEED ST STE D, SOLDOTNA, AK 99669-7570
(907) 262-6454
(907) 262-0832
Mailing address
291 N FIREWEED ST, SOLDOTNA, AK 99669-7540
(907) 262-6454
(907) 262-0832
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
264120
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
264120
AK. BUSINESS LICENSE
AK
01
—
4127920001
DMERC SUPPLIER NO.
AK
05
—
MDG 575
—
AK
Enumeration date
06/14/2005
Last updated
03/14/2024
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