Provider Demographics
NPI:1689880247
Name:VETERANS AFAIRS OUTPATIENT C
Entity Type:Organization
Organization Name:VETERANS AFAIRS OUTPATIENT C
Other - Org Name:V.A. OUTPATIENT CLINIC (119)
Other - Org Type:Other Name
Authorized Official - Title/Position:STAFF CLERK
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MORSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-257-4750
Mailing Address - Street 1:15701 ROBIN HOOD DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-5010
Mailing Address - Country:US
Mailing Address - Phone:907-345-5700
Mailing Address - Fax:
Practice Address - Street 1:15701 ROBIN HOOD DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99516-5010
Practice Address - Country:US
Practice Address - Phone:907-345-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK261QV0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA