Basic Information
| Provider Information | |||||||||
| NPI: | 1720062524 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHEAST ALASKA REGIONAL HEALTH CONSORTIUM | ||||||||
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| OtherOrganizationName: | SEARHC MT. EDGECUMBE MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3100 CHANNEL DR | ||||||||
| Address2: | STE 300 | ||||||||
| City: | JUNEAU | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074634074 | ||||||||
| FaxNumber: | 9074631510 | ||||||||
| Practice Location | |||||||||
| Address1: | 222 TONGASS DR | ||||||||
| Address2: | |||||||||
| City: | SITKA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 998359416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9079662411 | ||||||||
| FaxNumber: | 9079668606 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2005 | ||||||||
| LastUpdateDate: | 02/02/2022 | ||||||||
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| AuthorizedOfficialLastName: | HARRIS | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9074634000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 02/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 70206 | AK | N | 193200000X MULTI-SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | 251B00000X | 70206 | AK | N | Agencies | Case Management | 261Q00000X | 70206 | AK | N | Ambulatory Health Care Facilities | Clinic/Center | 261QA1903X | 70206 | AK | N | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical | 261QH0700X | 70206 | AK | N | Ambulatory Health Care Facilities | Clinic/Center | Hearing and Speech | 261QI0500X | N | Ambulatory Health Care Facilities | Clinic/Center | Infusion Therapy | 261QM0850X | 70206 | AK | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 261QM0855X | 70206 | AK | N | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 261QP2000X | 70206 | AK | N | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | 261QR0405X | 70206 | AK | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | 261QX0100X | 70206 | AK | N | Ambulatory Health Care Facilities | Clinic/Center | Occupational Medicine | 273R00000X | 70206 | AK | N | Hospital Units | Psychiatric Unit | 332B00000X | 70206 | AK | N | Suppliers | Durable Medical Equipment & Medical Supplies | 3416A0800X | 70206 | AK | N | Transportation Services | Ambulance | Air Transport | 282NC0060X | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 1005604 | 05 | AK | MEDICAID | DDG222 | 05 | AK | MEDICAID | MDG632 | 05 | AK | MEDICAID | MDG633 | 05 | AK | MEDICAID | HA9710 | 05 | AK | MEDICAID | HS-08-OP | 05 | AK | MEDICAID | HS-08-AS | 05 | AK | MEDICAID | HS-08-IP | 05 | AK | MEDICAID | MS6274 | 05 | AK | MEDICAID | PH7403 | 05 | AK | MEDICAID | AA6274 | 05 | AK | MEDICAID | MDG627 | 05 | AK | MEDICAID | 70206 | 01 | AK | BUSINESS LICENSE | OTHER |