Provider Demographics
NPI:1639249683
Name:HOONAH MEDICAL CENTER
Entity type:Organization
Organization Name:HOONAH MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LEAD PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:907-945-3235
Mailing Address - Street 1:PO BOX 602
Mailing Address - Street 2:
Mailing Address - City:HOONAH
Mailing Address - State:AK
Mailing Address - Zip Code:99829-0602
Mailing Address - Country:US
Mailing Address - Phone:907-945-3235
Mailing Address - Fax:907-945-3239
Practice Address - Street 1:568 RAVIN DRIVE
Practice Address - Street 2:
Practice Address - City:HOONAH
Practice Address - State:AK
Practice Address - Zip Code:99829-0602
Practice Address - Country:US
Practice Address - Phone:907-945-3235
Practice Address - Fax:907-945-3239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1505261QR1300X
207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCL2382Medicaid