Basic Information
Provider Information | |||||||||
NPI: | 1730548462 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SOUTHEAST ALASKA REGIONAL HEALTH CONSORTIUM | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3100 CHANNEL DR, STE 300 | ||||||||
Address2: |   | ||||||||
City: | JUNEAU | ||||||||
State: | AK | ||||||||
PostalCode: | 99801 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9074634074 | ||||||||
FaxNumber: | 9074631510 | ||||||||
Practice Location | |||||||||
Address1: | 222 TONGASS BLVD | ||||||||
Address2: |   | ||||||||
City: | SITKA | ||||||||
State: | AK | ||||||||
PostalCode: | 99835 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9074636644 | ||||||||
FaxNumber: | 9074631510 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/23/2016 | ||||||||
LastUpdateDate: | 05/25/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | NEUMEISTER | ||||||||
AuthorizedOfficialFirstName: | DANIEL | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
AuthorizedOfficialTelephone: | 9074634000 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | SEARHC | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 275N00000X | 70206 | AK | N |   | Hospital Units | Medicare Defined Swing Bed Unit |   | 282NC0060X | 70206 | AK | Y |   | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
ID | Type | State | Issuer | Description | 1005604 | 05 | AK |   | MEDICAID |