Basic Information
| Provider Information | |||||||||
| NPI: | 1861688236 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SLEEP MEDICINE ALASKA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2440 E TUDOR RD | ||||||||
| Address2: | PMB 185 | ||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995071185 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077466962 | ||||||||
| FaxNumber: | 9077466961 | ||||||||
| Practice Location | |||||||||
| Address1: | 3200 PROVIDENCE DR | ||||||||
| Address2: | SLEEP DISRODER CENTER MED CENTER | ||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995084615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9072613650 | ||||||||
| FaxNumber: | 9072614810 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2007 | ||||||||
| LastUpdateDate: | 10/01/2008 | ||||||||
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| AuthorizedOfficialLastName: | MORRIS | ||||||||
| AuthorizedOfficialFirstName: | ANNE | ||||||||
| AuthorizedOfficialMiddleName: | HANNA | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9072613650 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS1200X | 1285 | AK | Y | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
ID Information
| ID | Type | State | Issuer | Description | MD12851 | 05 | AK | MEDICAID |