1710262175 NPI number — ANCHORAGE SCHOOL BASED HEALTH CENTERS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710262175 NPI number — ANCHORAGE SCHOOL BASED HEALTH CENTERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANCHORAGE SCHOOL BASED HEALTH CENTERS
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:
1710262175
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2121 ABBOTT RD STE 202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99507-4450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-802-1500
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 BRAGAW ST
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:
99508-1307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-522-7090
Provider Business Practice Location Address Fax Number:
907-522-7095
Provider Enumeration Date:
10/18/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CUMMINGS
Authorized Official First Name:
JOANNE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
907-802-1500

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1021422 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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