BETHEL FAMILY CLINIC NPI 1124078019

NPI Information

NPI: 1124078019
Provider Name: BETHEL FAMILY CLINIC
Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

CLIA Number: 02D0705422

Address:
631 MAIN STREET
BETHEL, AK
ZIP 99559
Phone: (907) 543-3773
Get Directions

BETHEL FAMILY CLINIC is a federally qualified health center (fqhc) clinic center in Bethel, AK. BETHEL FAMILY CLINIC NPI is 1124078019. The provider is registered as an organization entity type.

The provider's business location address is:

631 MAIN STREET
BETHEL, AK
ZIP 99559-908
Phone: (907) 543-3773
Fax: (907) 543-3545

The provider's authorized official is Suzanne Niemi .
The authorized official title is Finance and has the following contact phone number (907) 543-9852.

The CLIA number assigned to this NPI record is 02D0705422 - community clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/11/2006 and was last updated on 11/27/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1029936	MEDICAID	ALASKA
2	02-1835	OTHER	ALASKA	MEDICARE PART A PTAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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