MEDICARE: SOUTH ANCHORAGE SURGERY CENTER, LLC

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	261QA1903X	Ambulatory Surgical Clinic/Center	950109	AK

General Provider Information

NPI Number	:	1336448968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH ANCHORAGE SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	1917 ABBOTT RD STE 103
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99507-3449
Country	:	US
Telephone Number	:	907-929-8712
Fax Number	:

Provider Business Practice Location Address
First Line	:	1917 ABBOTT RD
Second Line	:	SUITE 103
City	:	ANCHORAGE
State	:	AK
Zip	:	99507-3448
Country	:	US
Telephone Number	:	907-770-3224
Fax Number	:

Authorized Official
Title or Position	:	SR. DIRECTOR OF REVENUE CYCLE
Name	:	PATRICIA BOU
Credential	:
Telephone Number	:	702-271-8476

Provider Enumeration Date	:	03/22/2011
Last Update Date	:	05/20/2026

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