Provider Demographics
NPI:1881765329
Name:SOUTH EAST ALASKA MEDICAL SUPPLIERS, INC.
Entity type:Organization
Organization Name:SOUTH EAST ALASKA MEDICAL SUPPLIERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILBUR
Authorized Official - Middle Name:MARAGANA
Authorized Official - Last Name:SANGSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-586-6880
Mailing Address - Street 1:5636 GLACIER HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-9508
Mailing Address - Country:US
Mailing Address - Phone:907-586-6880
Mailing Address - Fax:907-586-6884
Practice Address - Street 1:5636 GLACIER HWY STE 200
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-9508
Practice Address - Country:US
Practice Address - Phone:907-586-6880
Practice Address - Fax:907-586-6884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2014-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK216626332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMS9255Medicaid
AKMS9255Medicaid