Healthcare Provider Details

I. General information

NPI: 1376711549
Provider Name (Legal Business Name): SOUTHEAST ALASKA PROSTHETICS AND ORTHOTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 03/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5193 BORCH ST
KETCHIKAN AK
99901-9036
US

IV. Provider business mailing address

PO BOX 7561
KETCHIKAN AK
99901-2561
US

V. Phone/Fax

Practice location:
  • Phone: 907-254-1276
  • Fax: 907-247-7868
Mailing address:
  • Phone: 907-254-1276
  • Fax: 907-247-7868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateAK

VIII. Authorized Official

Name: ELIZABETH EINSET
Title or Position: OWNER
Credential: CPO
Phone: 907-254-1276