Provider Demographics
NPI:1750591822
Name:STATE OF ALASKA DEPT. HLTH & SOC SERV DIV. PUB HLTH SPECIALTY CLINICS
Entity type:Organization
Organization Name:STATE OF ALASKA DEPT. HLTH & SOC SERV DIV. PUB HLTH SPECIALTY CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WCFH SECTION CHIEF
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-269-3400
Mailing Address - Street 1:4701 BUSINESS PARK BLVD
Mailing Address - Street 2:SUITE 20 BLDG J
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-7123
Mailing Address - Country:US
Mailing Address - Phone:907-269-3400
Mailing Address - Fax:907-269-3432
Practice Address - Street 1:4701 BUSINESS PARK BLVD
Practice Address - Street 2:SUITE 20 BLDG J
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-7123
Practice Address - Country:US
Practice Address - Phone:907-269-3400
Practice Address - Fax:907-269-3432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare