Healthcare Provider Details

I. General information

NPI: 1821380312
Provider Name (Legal Business Name): CPM EXSPRESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 05/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 BELLEVUE CIR
ANCHORAGE AK
99515-3115
US

IV. Provider business mailing address

1621 BELLEVUE CIR
ANCHORAGE AK
99515-3115
US

V. Phone/Fax

Practice location:
  • Phone: 907-344-6216
  • Fax: 907-349-1372
Mailing address:
  • Phone: 907-344-6216
  • Fax: 907-349-1372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number954274
License Number StateAK

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. JERRY WILLIAM HARRIS
Title or Position: OWNER
Credential:
Phone: 907-344-6216