Provider Demographics
NPI:1184160905
Name:JUNEAU OBSTETRICS AND GYNECOLOGY, P.C.
Entity type:Organization
Organization Name:JUNEAU OBSTETRICS AND GYNECOLOGY, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:NEWBURY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:907-586-1717
Mailing Address - Street 1:3268 HOSPITAL DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-7800
Mailing Address - Country:US
Mailing Address - Phone:907-586-1717
Mailing Address - Fax:907-586-2677
Practice Address - Street 1:3268 HOSPITAL DR
Practice Address - Street 2:SUITE B
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7800
Practice Address - Country:US
Practice Address - Phone:907-586-1717
Practice Address - Fax:907-586-2677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2017-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKMD2531261QA1903X
AKNP0168261QM2500X
AK107902261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1020712Medicaid
AK1020712Medicaid