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1720062524

NPI Code Detail

MEDICARE: SOUTHEAST ALASKA REGIONAL HEALTH CONSORTIUM

MEDICARE: SOUTHEAST ALASKA REGIONAL HEALTH CONSORTIUM

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	213E00000X	Podiatrist	70206	AK
2	251B00000X	Case Management Agency	70206	AK
3	261Q00000X	Clinic/Center	70206	AK
4	261QA1903X	Ambulatory Surgical Clinic/Center	70206	AK
5	261QH0700X	Hearing and Speech Clinic/Center	70206	AK
6	261QI0500X	Infusion Therapy Clinic/Center
7	261QM0850X	Adult Mental Health Clinic/Center	70206	AK
8	261QM0855X	Adolescent and Children Mental Health Clinic/Center	70206	AK
9	261QP2000X	Physical Therapy Clinic/Center	70206	AK
10	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	70206	AK
11	261QX0100X	Occupational Medicine Clinic/Center	70206	AK
12	273R00000X	Psychiatric Hospital Unit	70206	AK
13	332B00000X	Durable Medical Equipment & Medical Supplies	70206	AK
14	3416A0800X	Air Ambulance	70206	AK
15	282NC0060X	Critical Access Hospital

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	70206	OTHER	AK	BUSINESS LICENSE

General Provider Information

NPI Number	:	1720062524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEAST ALASKA REGIONAL HEALTH CONSORTIUM

Provider Business Mailing Address
First Line	:	3100 CHANNEL DR
Second Line	:	STE 300
City	:	JUNEAU
State	:	AK
Zip	:	99801
Country	:	US
Telephone Number	:	907-463-4074
Fax Number	:	907-463-1510

Provider Business Practice Location Address
First Line	:	222 TONGASS DR
Second Line	:
City	:	SITKA
State	:	AK
Zip	:	99835-9416
Country	:	US
Telephone Number	:	907-966-2411
Fax Number	:	907-966-8606

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. DANIEL HARRIS
Credential	:
Telephone Number	:	907-463-4000

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	02/02/2022

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1124018486 — MRS. JEANETTE SUSAN BERRY CRNA
Practice Location Address:

222 TONGASS DR
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99835-9416

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1548245871 — SOUTH EAST ALASKA REGIONAL HEALTH CONSORTIUM
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1073598306 — SOUTH EAST ALASKA REGIONAL HEALTH CONSOTIUM - DRUG AND ALCOHOL
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1437136041 — MS. TIFFANY NICOLLE ANDRES MS, RD
Practice Location Address:

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1124005731 — DR. JOHN A BACIOCCO MD
Practice Location Address:

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1710964341 — MS. NANCY JO BLEIER LCSW
Practice Location Address:

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99835-9416

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Directions to “SOUTHEAST ALASKA REGIONAL HEALTH CONSORTIUM ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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