Provider Demographics
NPI:1043345259
Name:ANCHORAGE ONCOLOGY CENTRE,LLC
Entity Type:Organization
Organization Name:ANCHORAGE ONCOLOGY CENTRE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUBRAMANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-569-2627
Mailing Address - Street 1:4231 LAKE OTIS PKWY
Mailing Address - Street 2:SUITE B2
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5214
Mailing Address - Country:US
Mailing Address - Phone:907-569-2627
Mailing Address - Fax:907-569-2626
Practice Address - Street 1:4231 LAKE OTIS PKWY
Practice Address - Street 2:SUITE B2
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5214
Practice Address - Country:US
Practice Address - Phone:907-569-2627
Practice Address - Fax:907-569-2626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA2285207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD2285Medicaid
AKAA2285OtherSTATE MEDICAL LICENSE
AKAA2285OtherSTATE MEDICAL LICENSE
AKK151297Medicare ID - Type Unspecified
AKMD2285Medicaid