Provider Demographics
NPI:1851710750
Name:CHINOOK MEDICAL SUPPLY
Entity Type:Organization
Organization Name:CHINOOK MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRATTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-929-4263
Mailing Address - Street 1:PO BOX 140371
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99514-0371
Mailing Address - Country:US
Mailing Address - Phone:907-929-4263
Mailing Address - Fax:
Practice Address - Street 1:1200 AIRPORT HEIGHTS DR STE 278
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2971
Practice Address - Country:US
Practice Address - Phone:907-929-4263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK987570332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies