Healthcare Provider Details

I. General information

NPI: 1841796869
Provider Name (Legal Business Name): SURGICAL SPECIALISTS OF ALASKA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 06/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 DEBARR RD STE 310
ANCHORAGE AK
99508
US

IV. Provider business mailing address

2751 DEBARR RD STE 310
ANCHORAGE AK
99508-6804
US

V. Phone/Fax

Practice location:
  • Phone: 907-277-9700
  • Fax: 907-258-8010
Mailing address:
  • Phone: 907-277-9700
  • Fax: 907-258-8010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MAGGIE CARO
Title or Position: PRACTICE MANAGER
Credential:
Phone: 907-277-9700