Provider Demographics
NPI:1598230088
Name:ALASKA SURGICAL GROUP, LLC
Entity Type:Organization
Organization Name:ALASKA SURGICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:PORTERA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:907-868-2075
Mailing Address - Street 1:3851 PIPER ST STE U230
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-6901
Mailing Address - Country:US
Mailing Address - Phone:907-868-2075
Mailing Address - Fax:907-312-5882
Practice Address - Street 1:3851 PIPER ST STE U230
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-6901
Practice Address - Country:US
Practice Address - Phone:907-868-2075
Practice Address - Fax:907-312-5882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty