Provider Demographics
NPI:1326506882
Name:RAYMOND GILLIGAN JR
Entity Type:Organization
Organization Name:RAYMOND GILLIGAN JR
Other - Org Name:RAYMOND GILLIGAN JR
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EMILIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:WOODWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-455-9255
Mailing Address - Street 1:3517 INDUSTRIAL AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-7737
Mailing Address - Country:US
Mailing Address - Phone:907-455-9255
Mailing Address - Fax:907-452-1789
Practice Address - Street 1:3517 INDUSTRIAL AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-7737
Practice Address - Country:US
Practice Address - Phone:907-455-9255
Practice Address - Fax:907-452-1789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-04
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1110253OtherBUSINESS LICENCE