1508854712 NPI number — DENALI ANESTHESIA, LLC

Table of content: (NPI 1508854712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508854712 NPI number — DENALI ANESTHESIA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENALI ANESTHESIA, LLC
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:
1508854712
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14700 28TH AVE N STE 20
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55447-4876
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-559-3779
Provider Business Mailing Address Fax Number:
763-450-3986

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2801 DEBARR RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99508-2932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-258-2149
Provider Business Practice Location Address Fax Number:
907-258-2147
Provider Enumeration Date:
10/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MORRIS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
304-276-3170

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1020823 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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