Basic Information
| Provider Information | |||||||||
| NPI: | 1710262175 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANCHORAGE SCHOOL BASED HEALTH CENTERS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1825 ACADEMY DR | ||||||||
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| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995075391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077427782 | ||||||||
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| Practice Location | |||||||||
| Address1: | 150 BRAGAW ST | ||||||||
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| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995081307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075227090 | ||||||||
| FaxNumber: | 9075227095 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2011 | ||||||||
| LastUpdateDate: | 12/12/2013 | ||||||||
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| AuthorizedOfficialLastName: | FARRIS | ||||||||
| AuthorizedOfficialFirstName: | BOBBY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 9077702380 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CHRISTIAN HEALTH ASSOCIATES | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1021422 | 05 | AK | MEDICAID |