Healthcare Provider Details

I. General information

NPI: 1689721144
Provider Name (Legal Business Name): PETERSBURG BOROUGH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HAUGEN DRIVE
PETERSBURG AK
99833
US

IV. Provider business mailing address

PO BOX 329
PETERSBURG AK
99833-0329
US

V. Phone/Fax

Practice location:
  • Phone: 907-772-3355
  • Fax:
Mailing address:
  • Phone: 907-772-4425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number5005
License Number StateAK

VIII. Authorized Official

Name: JODY TOW
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 907-772-4425