Provider Demographics
NPI: | 1033542899 |
---|---|
Name: | ALASKA NEPHROLOGISTS LLC |
Entity Type: | Organization |
Organization Name: | ALASKA NEPHROLOGISTS LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | BILLING AGENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JOSEPH |
Authorized Official - Middle Name: | E |
Authorized Official - Last Name: | BEATY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 907-770-2380 |
Mailing Address - Street 1: | PO BOX 4049 |
Mailing Address - Street 2: | |
Mailing Address - City: | PORTLAND |
Mailing Address - State: | OR |
Mailing Address - Zip Code: | 97208-4049 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3300 PROVIDENCE DR |
Practice Address - Street 2: | SUITE 304 |
Practice Address - City: | ANCHORAGE |
Practice Address - State: | AK |
Practice Address - Zip Code: | 99508-4690 |
Practice Address - Country: | US |
Practice Address - Phone: | 907-212-4840 |
Practice Address - Fax: | 907-212-4820 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-08-15 |
Last Update Date: | 2013-08-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AK | 992752 | 207RN0300X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | Group - Single Specialty |