| Organization Name: | KIC TRIBAL HEALTH CLINIC |
| NPI Number: | 1043533946 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARSHA M RAMIREZ (DIABETES COORDINATOR) |
| Mailing Address: | 2960 Tongass Ave Ketchikan |
| State: | AK US |
| Postal Code: | 999015742 |
| Phone Number: | 9072284900 |
| Fax Number: | 9072284905 |
| NPI Enumeration Date: | 03/05/2010 |
| NPI Last Update Date: | 03/05/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QF0400X |
| License Number: | 10728 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AK |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
| Taxonomy Definition: | |