Healthcare Provider Details

I. General information

NPI: 1417771353
Provider Name (Legal Business Name): ALASKA CHILDREN'S URGENT CARE AND OUTREACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 E 36TH AVE STE 100
ANCHORAGE AK
99503-4166
US

IV. Provider business mailing address

30535 EAGLE RIVER RD
EAGLE RIVER AK
99577-9755
US

V. Phone/Fax

Practice location:
  • Phone: 907-201-7801
  • Fax: 907-222-5093
Mailing address:
  • Phone: 907-201-7801
  • Fax: 907-222-5093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JENNIFER ELISABETH AUSTIN
Title or Position: MEDICAL DIRECTOR, OWNER
Credential: APRN
Phone: 907-201-7801