Provider Demographics
NPI:1033128335
Name:ALASKA COLORECTAL SURGERY, PC
Entity Type:Organization
Organization Name:ALASKA COLORECTAL SURGERY, PC
Other - Org Name:JUNE M. GEORGE, MD, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-222-1401
Mailing Address - Street 1:2751 DEBARR RD
Mailing Address - Street 2:STE 280
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2953
Mailing Address - Country:US
Mailing Address - Phone:907-222-1401
Mailing Address - Fax:907-222-1402
Practice Address - Street 1:2751 DEBARR RD
Practice Address - Street 2:STE 280
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2953
Practice Address - Country:US
Practice Address - Phone:907-222-1401
Practice Address - Fax:907-222-1402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4148208C00000X
AK450363AS0400X
AK838363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD41481Medicaid
AKMDG621Medicaid
AKNP4062Medicaid
AKNP4062Medicaid
AKR86112Medicare UPIN
AKK151945Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID
AKK153341Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID
AKMD41481Medicaid
AKK151946Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID
AKK151944Medicare PIN