Provider Demographics
NPI:1841386117
Name:SOUTHEAST URGENT CARE INCORPORATED
Entity Type:Organization
Organization Name:SOUTHEAST URGENT CARE INCORPORATED
Other - Org Name:JUNEAU URGENT AND FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:MCGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-796-9532
Mailing Address - Street 1:8505 OLD DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-8042
Mailing Address - Country:US
Mailing Address - Phone:907-790-4111
Mailing Address - Fax:907-790-3111
Practice Address - Street 1:8505 OLD DAIRY RD
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8042
Practice Address - Country:US
Practice Address - Phone:907-790-4111
Practice Address - Fax:907-790-3111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5909207P00000X, 332900000X
207Q00000X, 261QP2300X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD85051Medicaid
AKMD10031Medicaid
AKK160807OtherMEDICARE PTAN
AKK160780OtherGROUP MEDICARE PTAN
AKF15401Medicare UPIN
AKMD10031Medicaid