Provider Demographics
NPI:1871020123
Name:COBURN HEALTH CONSULTING LLC
Entity Type:Organization
Organization Name:COBURN HEALTH CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:COBURN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:907-854-8840
Mailing Address - Street 1:18828 MOOSE PLACE
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-6645
Mailing Address - Country:US
Mailing Address - Phone:907-854-8840
Mailing Address - Fax:
Practice Address - Street 1:4401 BUSINESS PARK BLVD # N-26
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-7172
Practice Address - Country:US
Practice Address - Phone:907-854-8840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-17
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1022977Medicaid