1023897485 NPI number — MCKINLEY CARE MEDICAL SUPPLIES

Table of content: (NPI 1023897485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023897485 NPI number — MCKINLEY CARE MEDICAL SUPPLIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCKINLEY CARE MEDICAL SUPPLIES
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:
1023897485
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4311 CONSTELLATION AVE UNIT G53
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:
99517-2735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-206-1200
Provider Business Mailing Address Fax Number:
907-802-4374

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
337 E 4TH AVE UNIT B
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:
99501-2664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-268-6576
Provider Business Practice Location Address Fax Number:
907-802-4374
Provider Enumeration Date:
09/25/2023

Additional Information

Authorized Official

Authorized Official Last Name:
POMERANTZ
Authorized Official First Name:
JACK
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
907-206-1200

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com