1265848295 NPI number — ORTHOPEDIC PHYSICIANS ANCHORAGE

Table of content: (NPI 1265848295)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265848295 NPI number — ORTHOPEDIC PHYSICIANS ANCHORAGE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPEDIC PHYSICIANS ANCHORAGE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265848295
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3801 LAKE OTIS PKWY
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99508-5234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-562-2277
Provider Business Mailing Address Fax Number:
907-563-3460

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2751 DEBARR RD
Provider Second Line Business Practice Location Address:
SUITE B-310
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99508-2952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-279-2663
Provider Business Practice Location Address Fax Number:
907-222-1774
Provider Enumeration Date:
07/10/2014

Additional Information

Authorized Official

Authorized Official Last Name:
CHANG
Authorized Official First Name:
EUGENE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
907-562-2277

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  79607D , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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