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General NPI Number Information
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NPI Number | 1285000497
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Entity Type | Organization
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Legal Business Name | HCIORTHO
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Dates
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Enumeration Date | 08/11/2015
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Last Update Date | 07/08/2019
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Provider Practice Location Address
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Address Line | 289 N FIREWEED ST STE B
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City | SOLDOTNA
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State | AK
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Zip | 99669-7570
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Country | US
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Telephone | 907-420-3540
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Fax | 907-312-5881
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Provider Business Mailing Address
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Address Line | PO BOX 1534
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City | SOLDOTNA
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State | AK
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Zip | 99669-1534
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Country | US
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Telephone | 413-770-1135
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Fax | 907-312-5881
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Authorized Official
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Title or Position | OWNER
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Name | HERBERT O BOTE
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Credential | MD
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Telephone | 413-770-1135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 8038
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License Number State | AK
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