Organization · Type 2 NPI

HSWL Fo Kodiak Det Ketchikan

Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center · Ketchikan, AK

NPI number 1285948877 Active

Practice location

1300 Stedman St
Ketchikan, AK 99901-6661

Fax (907) 228-0255

Specialties and licenses

Taxonomy	Code	License
Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center Primary	261QM1101X	None listed
Military/U.S. Coast Guard Pharmacy	332000000X	None listed

Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center: That part of a "fixed" (non-temporary, non-deployed) DoD or Coast Guard entity furnishing surgical procedures requiring medically supervised recovery. Similar to a civilian ambulatory surgical center. May be in shared resources with a DoD or Coast Guard Clinic or a DoD Hospital. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport. Includes initial "take home" pharmace…

18 other providers at this address

NPI record

NPI: 1285948877
Entity type: Organization (Type 2)
Issued: Aug 6, 2010
Last updated: Aug 6, 2010
Status: Active
Subpart: Yes of U.s. Coast Guard

Other names

<unavail>
Integrated Support Command Ketchikan · former legal business name

Authorized official

Robert Bidwell
Clinic Administrator
(907) 228-0320

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1285948877

HSWL Fo Kodiak Det Ketchikan's National Provider Identifier is 1285948877, issued on Aug 6, 2010. The primary taxonomy on file is Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center (261QM1101X), and the practice location is in Ketchikan, AK. The record was last updated on Aug 6, 2010.