Provider Demographics
NPI:1609942754
Name:INTERIOR COMMUNITY HEALTH CENTER
Entity type:Organization
Organization Name:INTERIOR COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXCUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:KILGORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-455-4567
Mailing Address - Street 1:1606 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-6407
Mailing Address - Country:US
Mailing Address - Phone:907-455-4567
Mailing Address - Fax:
Practice Address - Street 1:USIBELLI SPUR RD
Practice Address - Street 2:TRI VALLEY COMMUNITY CENTER
Practice Address - City:HEALY
Practice Address - State:AK
Practice Address - Zip Code:99743
Practice Address - Country:US
Practice Address - Phone:907-455-4567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Not Answered261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Not Answered261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health