Provider Demographics
NPI:1902077829
Name:CHUGACHMIUT
Entity Type:Organization
Organization Name:CHUGACHMIUT
Other - Org Name:NANWALEK CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH SERVICES DIVISION DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-562-4155
Mailing Address - Street 1:1840 BRAGAW ST STE 110
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-3463
Mailing Address - Country:US
Mailing Address - Phone:907-562-4155
Mailing Address - Fax:907-563-2891
Practice Address - Street 1:1 MAQIQ STREET
Practice Address - Street 2:
Practice Address - City:NANWALEK
Practice Address - State:AK
Practice Address - Zip Code:99603-6623
Practice Address - Country:US
Practice Address - Phone:907-281-2250
Practice Address - Fax:907-281-2244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1021384Medicaid