1497842553 NPI number — STATE OF ALASKA DEPARTMENT OF ADMINISTRATION

Table of content: (NPI 1497842553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497842553 NPI number — STATE OF ALASKA DEPARTMENT OF ADMINISTRATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STATE OF ALASKA DEPARTMENT OF ADMINISTRATION
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:
1497842553
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3700 PIPER ST.
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:
99508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-269-7100
Provider Business Mailing Address Fax Number:
907-269-7251

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3700 PIPER ST
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:
99508-4665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-269-7100
Provider Business Practice Location Address Fax Number:
907-269-7251
Provider Enumeration Date:
10/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RING
Authorized Official First Name:
MARIE
Authorized Official Middle Name:
E. (MELISSA)
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
907-269-7100

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: K0000ZBBBB . This is a "PTAN - MEDICARE PART B NUMBER" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".




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