KODIAK ISLAND AMBULATORY CARE CLINIC INC. NPI 1366596504

NPI Information

NPI: 1366596504
Provider Name: KODIAK ISLAND AMBULATORY CARE CLINIC INC.
Classification: Clinic/Center - 261QU0200X
Entity Type: Organization

Specialization: Urgent Care

CLIA Number: 02D0985615

Address:
202 CENTER AVE
STE. 102
KODIAK, AK
ZIP 99615
Phone: (907) 486-6188
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KODIAK ISLAND AMBULATORY CARE CLINIC INC. is an urgent care clinic center in Kodiak, AK. KODIAK ISLAND AMBULATORY CARE CLINIC INC. NPI is 1366596504. The provider is registered as an organization entity type.

The provider's business location address is:

202 CENTER AVE
STE. 102
KODIAK, AK
ZIP 99615-126
Phone: (907) 486-6188
Fax: (907) 486-6146

The provider's authorized official is John M. Koller .
The authorized official title is President and has the following contact phone number (907) 486-6188.

The CLIA number assigned to this NPI record is 02D0985615 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 1/23/2007 and was last updated on 5/16/2011.

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	261QU0200X	Clinic/Center	Urgent Care	DL282350	ALASKA	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	K162500	OTHER		MEDICARE PTAN
2	DL282350	OTHER	ALASKA	BUSINESS LICENSE NUMBER
3	MD10072	MEDICAID	ALASKA
4	=========	OTHER		TAX ID
5	02D0985615	OTHER	ALASKA	CLIA NUMBER
6	6270850001	OTHER		MEDICARE DME
7	G35861	MEDICARE UPIN

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

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