Organization
TOK COMMUNITY CLINIC, INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK LE ROY RUTLEDGE (AGENT)
(907) 883-5873
Entity
Organization
Contact information
Practice address
MILE 124 TOK CUTOFF, TOK, AK 99780-0033
(907) 883-5873
(907) 883-3640
Mailing address
PO BOX 33, TOK, AK 99780-0033
(907) 883-5873
(907) 883-3640
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
6185
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GA6185
—
AK
Enumeration date
05/31/2005
Last updated
12/06/2017
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