Healthcare Provider Details

I. General information

NPI: 1396552964
Provider Name (Legal Business Name): CHUGACH SPORTS FOOT AND ANKLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 09/13/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 LAKE OTIS PKWY STE 300
ANCHORAGE AK
99508-5230
US

IV. Provider business mailing address

1120 HUFFMAN RD STE 24-550
ANCHORAGE AK
99515-3516
US

V. Phone/Fax

Practice location:
  • Phone: 907-931-1726
  • Fax: 907-931-9946
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: JARED KERN
Title or Position: MANAGER
Credential: DPM
Phone: 907-931-1726