Provider Demographics
NPI:1669843074
Name:ALASKA BREAST CARE SPECIALIST, PC
Entity Type:Organization
Organization Name:ALASKA BREAST CARE SPECIALIST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATION
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURINE
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-585-2391
Mailing Address - Street 1:2741 DEBARR RD STE 402
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2980
Mailing Address - Country:US
Mailing Address - Phone:907-222-2950
Mailing Address - Fax:
Practice Address - Street 1:2741 DEBARR RD STE 402
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2980
Practice Address - Country:US
Practice Address - Phone:907-222-2950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK8158174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty