| NPI | 1285948877 |
|---|---|
| Former Legal Business Name | INTEGRATED SUPPORT COMMAND KETCHIKAN |
| Entity Type | Organization |
| Authorized Contact | ROBERT BIDWELL Clinic Administrator 907-228-0320 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM1101X Clinic/Center, Military and U.S. Coast Guard Ambulatory Procedure |
| Additional Taxonomies | 332000000X MilitaryU.S. Coast Guard Pharmacy |
| Enumeration Date | 2010-08-06 |
| Last Update Date | 2010-08-06 |