Provider Demographics
NPI:1720672173
Name:ANCHORAGE FRACTURE AND ORTHOPAEDIC CLINIC, PC
Entity Type:Organization
Organization Name:ANCHORAGE FRACTURE AND ORTHOPAEDIC CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:GENEVIEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BASSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-339-2455
Mailing Address - Street 1:3831 PIPER ST STE S220
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4680
Mailing Address - Country:US
Mailing Address - Phone:907-339-2455
Mailing Address - Fax:907-561-3967
Practice Address - Street 1:12350 INDUSTRY WAY STE 110
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-4301
Practice Address - Country:US
Practice Address - Phone:907-336-3145
Practice Address - Fax:907-561-8314
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANCHORAGE FRACTURE AND ORTHOPAEDIC CLINIC, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1698199Medicaid