Provider Demographics
NPI:1801309042
Name:ONLINE CARE GROUP ALASKA
Entity type:Organization
Organization Name:ONLINE CARE GROUP ALASKA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:EZRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-204-3500
Mailing Address - Street 1:200 W. 34TH AVE
Mailing Address - Street 2:PO BOX 585
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503
Mailing Address - Country:US
Mailing Address - Phone:617-204-3553
Mailing Address - Fax:
Practice Address - Street 1:200 W. 34TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503
Practice Address - Country:US
Practice Address - Phone:617-204-3553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty