Provider Demographics
NPI:1871529628
Name:YAKUTAT TRIBAL HEALTH BOARD
Entity type:Organization
Organization Name:YAKUTAT TRIBAL HEALTH BOARD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:WASSILLIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-784-3275
Mailing Address - Street 1:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:YAKUTAT
Mailing Address - State:AK
Mailing Address - Zip Code:99689-0112
Mailing Address - Country:US
Mailing Address - Phone:907-784-3275
Mailing Address - Fax:907-784-3263
Practice Address - Street 1:115 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:YAKUTAT
Practice Address - State:AK
Practice Address - Zip Code:99689
Practice Address - Country:US
Practice Address - Phone:907-784-3275
Practice Address - Fax:907-784-3263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK288254261Q00000X
363A00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMEDICAIDMedicaid
AKK151785Medicare ID - Type UnspecifiedPROVIDER ID
AK02 3800Medicare ID - Type UnspecifiedBILLING NUMBER