Provider Demographics
NPI:1699875450
Name:GENEVA WOODS SURGICAL CENTER INC
Entity type:Organization
Organization Name:GENEVA WOODS SURGICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:ENDRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-562-4764
Mailing Address - Street 1:3730 RHONE CIR
Mailing Address - Street 2:STE 100
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5054
Mailing Address - Country:US
Mailing Address - Phone:907-562-4764
Mailing Address - Fax:907-561-8519
Practice Address - Street 1:3730 RHONE CIR
Practice Address - Street 2:STE 100
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5054
Practice Address - Country:US
Practice Address - Phone:907-562-4764
Practice Address - Fax:907-561-8519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK58236261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCL0635Medicaid
AK=========OtherTIN
AK=========OtherTIN