Healthcare Provider Details

I. General information

NPI: 1912541384
Provider Name (Legal Business Name): ALASKA ANESTHESIA & PEDIATRICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 W NORTHERN LIGHTS BLVD SUITE 110
ANCHORAGE AK
99503
US

IV. Provider business mailing address

PO BOX 241889
ANCHORAGE AK
99524-1889
US

V. Phone/Fax

Practice location:
  • Phone: 907-563-1777
  • Fax: 907-561-7464
Mailing address:
  • Phone: 907-751-8138
  • Fax: 907-561-7464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: KATIE P GREEN
Title or Position: OWNER
Credential: MD
Phone: 907-205-0332