Healthcare Provider Details

I. General information

NPI: 1609942549
Provider Name (Legal Business Name): COOPER LANDING EMERGENCY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38748 A SNUG HARBOR ROAD
COOPER LANDING AK
99572-0776
US

IV. Provider business mailing address

PO BOX 510
COOPER LANDING AK
99572-0510
US

V. Phone/Fax

Practice location:
  • Phone: 907-595-1800
  • Fax: 907-595-1800
Mailing address:
  • Phone: 907-595-1800
  • Fax: 907-595-1800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number712498
License Number StateAK

VIII. Authorized Official

Name: KAY THOMAS
Title or Position: TREASURER
Credential:
Phone: 907-595-1800