1316280209 NPI number — RBS EVOLUTION OF ALASKA LLC

Table of content: (NPI 1316280209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316280209 NPI number — RBS EVOLUTION OF ALASKA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RBS EVOLUTION OF ALASKA LLC
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:
PENINSULA RADIATION ONCOLOGY CENTER
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:
1316280209
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1044 JACKSON FELTS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOELTON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37080-4839
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-746-4711
Provider Business Mailing Address Fax Number:
615-296-0952

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
240 HOSPITAL PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOLDOTNA
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99669-7559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-222-7762
Provider Business Practice Location Address Fax Number:
907-222-7764
Provider Enumeration Date:
03/29/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
615-746-4711

Provider Taxonomy Codes

  • Taxonomy code: 171100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 175F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2278P1004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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