Provider Demographics
NPI:1376711549
Name:SOUTHEAST ALASKA PROSTHETICS AND ORTHOTICS LLC
Entity Type:Organization
Organization Name:SOUTHEAST ALASKA PROSTHETICS AND ORTHOTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:EINSET
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:907-254-1276
Mailing Address - Street 1:PO BOX 7561
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-2561
Mailing Address - Country:US
Mailing Address - Phone:907-254-1276
Mailing Address - Fax:907-247-7868
Practice Address - Street 1:5193 BORCH ST
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-9036
Practice Address - Country:US
Practice Address - Phone:907-254-1276
Practice Address - Fax:907-247-7868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK4406980001Medicare NSC