Provider Demographics
NPI:1366241929
Name:DAHL MEMORIAL CLINIC, INC
Entity type:Organization
Organization Name:DAHL MEMORIAL CLINIC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-983-9742
Mailing Address - Street 1:PO BOX 537
Mailing Address - Street 2:
Mailing Address - City:SKAGWAY
Mailing Address - State:AK
Mailing Address - Zip Code:99840-0537
Mailing Address - Country:US
Mailing Address - Phone:907-983-2255
Mailing Address - Fax:907-983-2739
Practice Address - Street 1:402 STATE ST
Practice Address - Street 2:
Practice Address - City:SKAGWAY
Practice Address - State:AK
Practice Address - Zip Code:99840
Practice Address - Country:US
Practice Address - Phone:844-944-9911
Practice Address - Fax:907-983-9712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-07
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK223387OtherBUSINESS LICENSE