Provider Demographics
NPI:1689876401
Name:RHENE MERKOURIS MD PC
Entity Type:Organization
Organization Name:RHENE MERKOURIS MD PC
Other - Org Name:ANCHORAGE OBGYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:RHENE
Authorized Official - Last Name:MERKOURIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-336-6375
Mailing Address - Street 1:PO BOX 231669
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99523-1669
Mailing Address - Country:US
Mailing Address - Phone:907-336-6375
Mailing Address - Fax:907-336-7211
Practice Address - Street 1:9701 BIRCH RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-6657
Practice Address - Country:US
Practice Address - Phone:907-336-6375
Practice Address - Fax:907-336-7211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4440174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD3589Medicaid
AKE95509Medicare UPIN
AKK152364Medicare PIN