Provider Demographics
NPI:1629100961
Name:PLANNED PARERTHOOD OF ALASKA
Entity Type:Organization
Organization Name:PLANNED PARERTHOOD OF ALASKA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CLOVER
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-770-9705
Mailing Address - Street 1:514 LAKE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835-7403
Mailing Address - Country:US
Mailing Address - Phone:907-747-3883
Mailing Address - Fax:907-747-8282
Practice Address - Street 1:4001 LAKE OTIS PKWY
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5211
Practice Address - Country:US
Practice Address - Phone:907-565-7526
Practice Address - Fax:907-565-7529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK125738261QF0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD86413Medicaid
AKNP3925Medicaid
AKFP3773Medicaid
AKNP3925Medicaid