Basic Information
| Provider Information | |||||||||
| NPI: | 1396349833 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANCHORAGE INTENSIVIST SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5380 TECH DATA DR STE 101 | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337603122 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2801 DEBARR RD | ||||||||
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| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995082932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9732511132 | ||||||||
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| ProviderEnumerationDate: | 11/25/2020 | ||||||||
| LastUpdateDate: | 11/25/2020 | ||||||||
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| AuthorizedOfficialLastName: | KONDAS | ||||||||
| AuthorizedOfficialFirstName: | KATHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9732511132 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
No ID Information.