Provider Demographics
NPI:1700343514
Name:ANCHOR ERUPTION ENTERPRISES LLC
Entity type:Organization
Organization Name:ANCHOR ERUPTION ENTERPRISES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAMSIDEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MS
Authorized Official - Phone:773-552-7426
Mailing Address - Street 1:4001 DALE ST STE 105
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5444
Mailing Address - Country:US
Mailing Address - Phone:907-357-7710
Mailing Address - Fax:907-357-7720
Practice Address - Street 1:4001 DALE ST STE 105
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5444
Practice Address - Country:US
Practice Address - Phone:773-552-7426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-28
Last Update Date:2019-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction MedicineGroup - Multi-Specialty