1154390094 NPI number — ANESTHESIA ASSOCIATES OF SOUTHEAST ALASKA INC

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 1154390094 NPI number — ANESTHESIA ASSOCIATES OF SOUTHEAST ALASKA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANESTHESIA ASSOCIATES OF SOUTHEAST ALASKA INC
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:
1154390094
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5319 SW WESTGATE DR
Provider Second Line Business Mailing Address:
241
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97221-2432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-297-7223
Provider Business Mailing Address Fax Number:
503-297-7603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3260 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JUNEAU
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-796-8433
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PARKER
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRESIDENT OWNER
Authorized Official Telephone Number:
907-789-4950

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  3164 , 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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