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General NPI Number Information
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NPI Number | 1396552964
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Entity Type | Organization
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Legal Business Name | CHUGACH SPORTS FOOT AND ANKLE, LLC
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Dates
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Enumeration Date | 12/16/2024
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 1917 ABBOTT RD STE 100
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City | ANCHORAGE
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State | AK
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Zip | 99507-3449
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Country | US
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Telephone | 907-931-1726
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Fax | 907-931-9946
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Provider Business Mailing Address
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Address Line | 1120 HUFFMAN RD STE 24-550
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City | ANCHORAGE
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State | AK
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Zip | 99515-3516
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JARED KERN
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Credential | DPM
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Telephone | 907-931-1726
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number |
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License Number State |
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