Healthcare Provider Details

I. General information

NPI: 1184160905
Provider Name (Legal Business Name): JUNEAU OBSTETRICS AND GYNECOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2017
Last Update Date: 07/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3268 HOSPITAL DR SUITE B
JUNEAU AK
99801-7800
US

IV. Provider business mailing address

3268 HOSPITAL DR SUITE B
JUNEAU AK
99801-7800
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberMD2531
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberNP0168
License Number StateAK
# 3
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number107902
License Number StateAK

VII. Legacy identifiers

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

# 1
Identifier1020712
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer

VIII. Authorized Official

Name: DR. NICHOLAS D. NEWBURY
Title or Position: PRESIDENT
Credential: D.O.
Phone: 907-586-1717