Healthcare Provider Details

I. General information

NPI: 1811693039
Provider Name (Legal Business Name): SOUTHEAST ALASKA REGIONAL HEALTH CONSORTIUM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2023
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 HOSPITAL DR UNIT 101
JUNEAU AK
99801-7863
US

IV. Provider business mailing address

3100 CHANNEL DR STE 300
JUNEAU AK
99801-7837
US

V. Phone/Fax

Practice location:
  • Phone: 907-586-1717
  • Fax: 907-586-2677
Mailing address:
  • Phone: 907-463-4074
  • Fax: 907-463-1510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL HARRIS
Title or Position: SEVP/CFO
Credential:
Phone: 907-463-4000