Healthcare Provider Details

I. General information

NPI: 1710262175
Provider Name (Legal Business Name): ANCHORAGE SCHOOL BASED HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2011
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BRAGAW ST
ANCHORAGE AK
99508-1307
US

IV. Provider business mailing address

2121 ABBOTT RD STE 202
ANCHORAGE AK
99507-4450
US

V. Phone/Fax

Practice location:
  • Phone: 907-522-7090
  • Fax: 907-522-7095
Mailing address:
  • Phone: 907-802-1500
  • Fax:

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:

# 1
Identifier1021422
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer

VIII. Authorized Official

Name: JOANNE L CUMMINGS
Title or Position: CFO
Credential:
Phone: 907-802-1500