Basic Information
| Provider Information | |||||||||
| NPI: | 1093712358 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHUGACH ANESTHESIA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14700 28TH AVE N STE 20 | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554474876 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635593779 | ||||||||
| FaxNumber: | 7634503986 | ||||||||
| Practice Location | |||||||||
| Address1: | 4100 LAKE OTIS PKWY STE 222 | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995085230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075506111 | ||||||||
| FaxNumber: | 9075506326 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | BEERLE | ||||||||
| AuthorizedOfficialFirstName: | BRION | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9075506111 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | AK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.