Healthcare Provider Details

I. General information

NPI: 1851725493
Provider Name (Legal Business Name): AK E-CAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2013
Last Update Date: 08/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

387 15TH ST W
DICKINSON ND
58601-3017
US

IV. Provider business mailing address

6035 BLUEBELL DR
ANCHORAGE AK
99516-5760
US

V. Phone/Fax

Practice location:
  • Phone: 701-214-6525
  • Fax:
Mailing address:
  • Phone: 701-214-6525
  • Fax: 187-776-9639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number130216
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number33431000
License Number StateND

VIII. Authorized Official

Name: CLAIRE GOLDSMITH
Title or Position: CFO
Credential:
Phone: 701-214-6525