Provider Demographics
NPI:1083907711
Name:INSIDE PASSAGE MIDWIFERY & NATURAL MEDICINE LLC
Entity Type:Organization
Organization Name:INSIDE PASSAGE MIDWIFERY & NATURAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:
Authorized Official - Credentials:ND, CDM
Authorized Official - Phone:907-463-2600
Mailing Address - Street 1:PO BOX 32222
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99803-2222
Mailing Address - Country:US
Mailing Address - Phone:907-463-2699
Mailing Address - Fax:907-790-3385
Practice Address - Street 1:11001 BLACK BEAR RD
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8783
Practice Address - Country:US
Practice Address - Phone:907-463-2600
Practice Address - Fax:907-790-3385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK38261QH0100X
AK42261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNM98881Medicaid