Provider Demographics
NPI:1417031618
Name:FIRST CITY MEDICINE LLC
Entity type:Organization
Organization Name:FIRST CITY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:N
Authorized Official - Last Name:SCHULZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-247-3301
Mailing Address - Street 1:212 CARLANNA LAKE RD STE 201
Mailing Address - Street 2:BOX 6755
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-5642
Mailing Address - Country:US
Mailing Address - Phone:907-247-3301
Mailing Address - Fax:907-247-3306
Practice Address - Street 1:212 CARLANNA LAKE RD STE 201
Practice Address - Street 2:BOX 6755
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5642
Practice Address - Country:US
Practice Address - Phone:907-247-3301
Practice Address - Fax:907-247-3306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK306825261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
153269Medicare ID - Type Unspecified