MEDICARE: ALASKA BLEEDING DISORDER CLINICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0000X	Hematology (Internal Medicine) Physician

General Provider Information

NPI Number	:	1003459298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALASKA BLEEDING DISORDER CLINICS

Provider Business Mailing Address
First Line	:	1200 AIRPORT HEIGHTS DR STE 101
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-2982
Country	:	US
Telephone Number	:	907-917-9235
Fax Number	:	907-891-7307

Provider Business Practice Location Address
First Line	:	1200 AIRPORT HEIGHTS DR STE 101
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-2982
Country	:	US
Telephone Number	:	907-917-9235
Fax Number	:	907-891-7307

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DAVE GROLLER
Credential	:
Telephone Number	:	907-917-9235

Provider Enumeration Date	:	10/21/2019
Last Update Date	:	02/12/2026

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