Healthcare Provider Details

I. General information

NPI: 1679603450
Provider Name (Legal Business Name): ALASKA TRANSPORTATION UNLIMITED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 FRONT ST
FAIRBANKS AK
99701-3435
US

IV. Provider business mailing address

543 FRONT ST
FAIRBANKS AK
99701-3435
US

V. Phone/Fax

Practice location:
  • Phone: 907-456-7474
  • Fax: 907-452-7171
Mailing address:
  • Phone: 907-456-7474
  • Fax: 907-452-7171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number223584
License Number StateAK

VIII. Authorized Official

Name: MR. WILLIAM EUGENE NORTHRUP
Title or Position: OPERATIONS ADMIN MGR
Credential:
Phone: 907-456-8536