Provider Demographics
NPI:1740206101
Name:VALLEY ORTHOPEDIC SURGERY PC DR CHARLES J KASE MD PC
Entity Type:Organization
Organization Name:VALLEY ORTHOPEDIC SURGERY PC DR CHARLES J KASE MD PC
Other - Org Name:DR. CHARLES KASE MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:KASE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-376-3255
Mailing Address - Street 1:6231 E MOUNTAIN GOAT CIR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-9334
Mailing Address - Country:US
Mailing Address - Phone:907-232-2492
Mailing Address - Fax:
Practice Address - Street 1:6231 E MOUNTAIN GOAT CIR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-9334
Practice Address - Country:US
Practice Address - Phone:907-232-2492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3416207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD1577Medicaid
F93409Medicare UPIN
AKMD1577Medicaid