1184010274 NPI number — ALASKA CARDIOTHORACIC SURGERY PC

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 1184010274 NPI number — ALASKA CARDIOTHORACIC SURGERY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALASKA CARDIOTHORACIC SURGERY PC
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:
6
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:
1184010274
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 84564
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98124-5864
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-770-2380
Provider Business Mailing Address Fax Number:
907-770-2341

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2741 DEBARR RD
Provider Second Line Business Practice Location Address:
SUITE C-416
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99508-2961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-258-4430
Provider Business Practice Location Address Fax Number:
907-258-4435
Provider Enumeration Date:
04/15/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BEATY
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
E
Authorized Official Title or Position:
BILLING AGENT
Authorized Official Telephone Number:
907-770-2380

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X , with the licence number:  1018733 , 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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