Provider Demographics
NPI:1285000497
Name:HCIORTHO
Entity Type:Organization
Organization Name:HCIORTHO
Other - Org Name:HCI ORTHO LLC DBA SPORTSMED ALASKA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:O
Authorized Official - Last Name:BOTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-770-1135
Mailing Address - Street 1:PO BOX 1534
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-1534
Mailing Address - Country:US
Mailing Address - Phone:413-770-1135
Mailing Address - Fax:907-312-5881
Practice Address - Street 1:289 N FIREWEED ST STE B
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7570
Practice Address - Country:US
Practice Address - Phone:907-420-3540
Practice Address - Fax:907-312-5881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-11
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK8038207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1633107Medicaid
AK1633107Medicaid