Provider Demographics
NPI:1700165537
Name:BICKNELL INC
Entity Type:Organization
Organization Name:BICKNELL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSCOE
Authorized Official - Middle Name:
Authorized Official - Last Name:BICKNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-789-5727
Mailing Address - Street 1:PO BOX 33517
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99803-3517
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2275 BRANDY LN
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8578
Practice Address - Country:US
Practice Address - Phone:907-789-5727
Practice Address - Fax:907-789-2644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK153481171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKEM0029Medicaid