Provider Demographics
NPI:1811027519
Name:STATE OF ALASKA
Entity Type:Organization
Organization Name:STATE OF ALASKA
Other - Org Name:API PHYSICIAN'S OUTPATIENT MENTAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:HOPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-269-7149
Mailing Address - Street 1:2800 PROVIDENCE DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4623
Mailing Address - Country:US
Mailing Address - Phone:907-269-7149
Mailing Address - Fax:907-269-7251
Practice Address - Street 1:2800 PROVIDENCE DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4623
Practice Address - Country:US
Practice Address - Phone:907-269-7149
Practice Address - Fax:907-269-7251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK45952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMH3990Medicaid