Provider Demographics
NPI:1508835299
Name:ALASKA DIGESTIVE CENTER, LLC
Entity Type:Organization
Organization Name:ALASKA DIGESTIVE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER AND AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:BALDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-234-5935
Mailing Address - Street 1:4048 LAUREL ST
Mailing Address - Street 2:SUITE 103A
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5333
Mailing Address - Country:US
Mailing Address - Phone:907-563-1750
Mailing Address - Fax:907-550-4403
Practice Address - Street 1:4048 LAUREL ST
Practice Address - Street 2:SUITE 103A
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5333
Practice Address - Country:US
Practice Address - Phone:907-563-1750
Practice Address - Fax:907-550-4403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK399OtherBLUE CROSS BLUE SHIELD
AK851285OtherDESSERT MUTUAL
AK7256536OtherAETNA
AK7256536OtherAETNA
AK153005Medicare PIN