Provider Demographics
NPI:1124074869
Name:ALASKA KIDNEY CONSULTANTS
Entity type:Organization
Organization Name:ALASKA KIDNEY CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-562-2712
Mailing Address - Street 1:3260 PROVIDENCE DR
Mailing Address - Street 2:STE 326
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4615
Mailing Address - Country:US
Mailing Address - Phone:907-562-2712
Mailing Address - Fax:907-562-6563
Practice Address - Street 1:3260 PROVIDENCE DR
Practice Address - Street 2:STE 326
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4615
Practice Address - Country:US
Practice Address - Phone:907-562-2712
Practice Address - Fax:907-562-6563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK294179207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty