Provider Demographics
NPI:1154739878
Name:ANCHORAGE SLEEP CENTER, LLC DBA KODIAK SLEEP CENTER
Entity type:Organization
Organization Name:ANCHORAGE SLEEP CENTER, LLC DBA KODIAK SLEEP CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-887-9520
Mailing Address - Street 1:510 W TUDOR RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-6649
Mailing Address - Country:US
Mailing Address - Phone:907-743-0050
Mailing Address - Fax:907-743-0060
Practice Address - Street 1:104 CENTER AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6393
Practice Address - Country:US
Practice Address - Phone:907-512-2060
Practice Address - Fax:907-512-2070
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANCHORAGE SLEEP CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1008468261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic