1780851998 NPI number — DENALI MESA CORPORATION

Table of content: (NPI 1780851998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780851998 NPI number — DENALI MESA CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENALI MESA CORPORATION
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:
FRONTIER THERAPY SERVICES
Provider Other Organization Name Type Code:
3
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:
1780851998
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
907 E DOWLING RD STE 26
Provider Second Line Business Mailing Address:
ANCHORAGE
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99518-1427
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-258-8618
Provider Business Mailing Address Fax Number:
907-563-9291

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2421 E TUDOR RD
Provider Second Line Business Practice Location Address:
STE 103
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99507-1128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-646-9774
Provider Business Practice Location Address Fax Number:
907-646-9775
Provider Enumeration Date:
05/15/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KINNEBREW
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
Authorized Official Title or Position:
OPERATIONS MANAGER
Authorized Official Telephone Number:
907-258-8618

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , 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)

  • Identifier: 193978501 . This is a "U.S. DEPARTMENT OF LABOR" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
  • Identifier: PT95101 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: PT1442 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".