Provider Demographics
NPI:1528490802
Name:BREAST CANCER DETECTION CENTER OF ALASKA (BCDC)
Entity type:Organization
Organization Name:BREAST CANCER DETECTION CENTER OF ALASKA (BCDC)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ODETTE
Authorized Official - Middle Name:BUTLER, EXECUTIVE
Authorized Official - Last Name:DIRECTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-479-3909
Mailing Address - Street 1:1905 COWLES ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-5914
Mailing Address - Country:US
Mailing Address - Phone:907-479-3909
Mailing Address - Fax:907-479-2215
Practice Address - Street 1:1905 COWLES ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5914
Practice Address - Country:US
Practice Address - Phone:907-479-3909
Practice Address - Fax:907-479-2215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK235774251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable