Healthcare Provider Details

I. General information

NPI: 1548723083
Provider Name (Legal Business Name): MISS TASHA R BIRD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 04/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 HOSPITAL ROAD
SAINT MARYS AK
99658
US

IV. Provider business mailing address

PO BOX 310
SAINT MARYS AK
99658-0310
US

V. Phone/Fax

Practice location:
  • Phone: 907-438-3500
  • Fax: 907-438-3540
Mailing address:
  • Phone: 907-438-3500
  • Fax: 907-438-3540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: