Provider Demographics
NPI:1265496061
Name:ANCHORAGE WOMEN'S CLINIC, LLC
Entity Type:Organization
Organization Name:ANCHORAGE WOMEN'S CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-561-7111
Mailing Address - Street 1:3260 PROVIDENCE DR STE 425
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4603
Mailing Address - Country:US
Mailing Address - Phone:907-561-7111
Mailing Address - Fax:907-770-7891
Practice Address - Street 1:3260 PROVIDENCE DR STE 425
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4603
Practice Address - Country:US
Practice Address - Phone:907-561-7111
Practice Address - Fax:907-770-7891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK312863207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK0000WFBHRMedicare ID - Type UnspecifiedGROUP MEDICARE NUMBER