Healthcare Provider Details

I. General information

NPI: 1063958452
Provider Name (Legal Business Name): SOUTHEAST ALASKA REGIONAL HEALTH CONSORTIUM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CANNERY SITE
EXCURSION INLET AK
99850
US

IV. Provider business mailing address

3100 CHANNEL DRIVE STE 300 ATTN: PROVIDER ENROLLMENT
JUNEAU AK
99801
US

V. Phone/Fax

Practice location:
  • Phone: 907-697-3008
  • Fax:
Mailing address:
  • Phone: 907-463-4000
  • Fax: 907-463-1510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL HARRIS
Title or Position: VP/CHIEF FINANCIAL OFFICER
Credential:
Phone: 907-463-4000