Kodiak Island Ambulatory Care Clinic Inc.

LBN: Kodiak Island Ambulatory Care Clinic Inc.
Kodiak Island Ambulatory Care Clinic Inc. is an health care organization with primary practice located at 202 Center Ave Ste. 102, Kodiak AK 99615-1126. The organization recently has only one registered license in Ambulatory Health Care Facilities / Urgent Care, which is considered as the primary health care specialty. Kodiak Island Ambulatory Care Clinic Inc. can be contacted via phone (907) 486-6188, or through Koller, John M. via phone (907) 486-6188.

Contact Information

Primary practice address
202 Center Ave Ste. 102 Kodiak AK 99615-1126
Phone: (907) 486-6188
Fax: (907) 486-6146
Website:
Map and Directions
Authorized official contact:
Name: Koller, John M. Doctor of Medicine (MD)
Phone: (907) 486-6188

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Urgent Care 261QU0200X DL282350 Alaska

Profile Details

NPI number 1366596504
LBN Legal business name Kodiak Island Ambulatory Care Clinic Inc.
DBA Doing business as
Authorized official Koller, John M. Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Jan 23rd, 2007
Last updated May 16th, 2011 - about 14 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1366596504 NPPES
Alaska Other 02D0985615 CLIA NUMBER
Alaska Other DL282350 CLIA NUMBER
Alaska Other 6270850001 CLIA NUMBER
Alaska Other K162500 CLIA NUMBER
Alaska MEDICAID MD10072 CLIA NUMBER

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