| NPI | 1720064884 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TODD LANE EMERSON Clinic Administrator 907-487-5757 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental |
| 291900000X Military Clinical Medical Laboratory (Licence: AK 02D0666660) | |
| 332000000X Military/U.S. Coast Guard Pharmacy (Licence: AK NCPDP0202414) | |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2008-07-28 |