Healthcare Provider Details

I. General information

NPI: 1194198747
Provider Name (Legal Business Name): ALASKA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2015
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 W NORTHERN LIGHTS BLVD STE 800
ANCHORAGE AK
99503-3984
US

IV. Provider business mailing address

188 W NORTHERN LIGHTS BLVD STE 800
ANCHORAGE AK
99503-3984
US

V. Phone/Fax

Practice location:
  • Phone: 907-276-2803
  • Fax: 907-278-8052
Mailing address:
  • Phone: 907-276-2803
  • Fax: 907-278-8052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
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: WILLIAM R CLARK
Title or Position: OWNER
Credential: MD
Phone: 907-276-2844