Provider Demographics
NPI:1598083222
Name:KILE SURGICAL SERVICES
Entity Type:Organization
Organization Name:KILE SURGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGICAL ASSIST/PHYSICIAN ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:KILE
Authorized Official - Suffix:
Authorized Official - Credentials:SA-C/PA-C
Authorized Official - Phone:907-351-3929
Mailing Address - Street 1:10618 KETCH CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-2429
Mailing Address - Country:US
Mailing Address - Phone:907-351-3929
Mailing Address - Fax:907-562-3525
Practice Address - Street 1:10618 KETCH CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-2429
Practice Address - Country:US
Practice Address - Phone:907-351-3929
Practice Address - Fax:907-562-3525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK853332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKK162255OtherMEDICARE/MEDICAID PROVIDER NUMBER