Basic Information
| Provider Information | |||||||||
| NPI: | 1184010274 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALASKA CARDIOTHORACIC SURGERY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 84564 | ||||||||
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| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981245864 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077702380 | ||||||||
| FaxNumber: | 9077702341 | ||||||||
| Practice Location | |||||||||
| Address1: | 2741 DEBARR RD | ||||||||
| Address2: | SUITE C-416 | ||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995082961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9072584430 | ||||||||
| FaxNumber: | 9072584435 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2015 | ||||||||
| LastUpdateDate: | 04/15/2015 | ||||||||
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| AuthorizedOfficialLastName: | BEATY | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING AGENT | ||||||||
| AuthorizedOfficialTelephone: | 9077702380 | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | 1018733 | AK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
No ID Information.