Provider Demographics
NPI:1740403047
Name:ALEUTIAN PRIBILOF ISLANDS ASSOC INC
Entity Type:Organization
Organization Name:ALEUTIAN PRIBILOF ISLANDS ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DIMITRI
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILEMONOF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-276-2700
Mailing Address - Street 1:201 E 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501
Mailing Address - Country:US
Mailing Address - Phone:907-276-2700
Mailing Address - Fax:907-222-4279
Practice Address - Street 1:201 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501
Practice Address - Country:US
Practice Address - Phone:907-276-2700
Practice Address - Fax:907-222-4295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK230280251X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPCG7331Medicaid