Healthcare Provider Details

I. General information

NPI: 1477891364
Provider Name (Legal Business Name): ALASKA HEART INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2013
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3220 PROVIDENCE DR SUITE E3-083
ANCHORAGE AK
99508-4679
US

IV. Provider business mailing address

3841 PIPER ST SUITE T100
ANCHORAGE AK
99508-4624
US

V. Phone/Fax

Practice location:
  • Phone: 907-561-3211
  • Fax: 907-562-7547
Mailing address:
  • Phone: 907-561-3211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number984380
License Number StateAK

VII. Legacy identifiers

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

# 1
Identifier02-C0001016
Identifier TypeOTHER
Identifier StateAK
Identifier IssuerMEDICARE
# 2
IdentifierK165540
Identifier TypeOTHER
Identifier StateAK
Identifier IssuerPTAN

VIII. Authorized Official

Name: DR. ALAN E SKOLNICK
Title or Position: TREASURER
Credential: M.D.
Phone: 907-561-3211