Provider Demographics
NPI:1689920142
Name:ALCHEMY ORTHOTICS AND PROSTHETICS
Entity Type:Organization
Organization Name:ALCHEMY ORTHOTICS AND PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:SUNDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:CPO, C PED
Authorized Official - Phone:907-562-0560
Mailing Address - Street 1:4048 LAUREL ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5389
Mailing Address - Country:US
Mailing Address - Phone:907-562-0560
Mailing Address - Fax:907-562-1617
Practice Address - Street 1:1405 KELLUM ST
Practice Address - Street 2:SUITE 201
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4189
Practice Address - Country:US
Practice Address - Phone:907-562-0560
Practice Address - Fax:907-562-1617
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALCHEMY ORHTOTICS AND PROSTHETICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK741113335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPO4558Medicaid