Provider Demographics
| NPI: | 1720062524 |
|---|---|
| Name: | SOUTHEAST ALASKA REGIONAL HEALTH CONSORTIUM |
| Entity type: | Organization |
| Organization Name: | SOUTHEAST ALASKA REGIONAL HEALTH CONSORTIUM |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CHIEF FINANCIAL OFFICER |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | DANIEL |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | HARRIS |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 907-463-4000 |
| Mailing Address - Street 1: | 3100 CHANNEL DR |
| Mailing Address - Street 2: | STE 300 |
| Mailing Address - City: | JUNEAU |
| Mailing Address - State: | AK |
| Mailing Address - Zip Code: | 99801 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 907-463-4074 |
| Mailing Address - Fax: | 907-463-1510 |
| Practice Address - Street 1: | 222 TONGASS DR |
| Practice Address - Street 2: | |
| Practice Address - City: | SITKA |
| Practice Address - State: | AK |
| Practice Address - Zip Code: | 99835-9416 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 907-966-2411 |
| Practice Address - Fax: | 907-966-8606 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2005-12-05 |
| Last Update Date: | 2022-02-02 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| AK | 70206 | 213E00000X, 251B00000X, 261Q00000X, 261QA1903X, 261QH0700X, 261QM0850X, 261QM0855X, 261QP2000X, 261QR0405X, 261QX0100X, 273R00000X, 332B00000X, 3416A0800X |
| 261QI0500X, 282NC0060X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 282NC0060X | Hospitals | General Acute Care Hospital | Critical Access | Group - Multi-Specialty |
| No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty | |
| No | 251B00000X | Agencies | Case Management | Group - Multi-Specialty | |
| No | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | ||
| No | 261QA1903X | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical | |
| No | 261QH0700X | Ambulatory Health Care Facilities | Clinic/Center | Hearing and Speech | |
| No | 261QI0500X | Ambulatory Health Care Facilities | Clinic/Center | Infusion Therapy | |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | |
| No | 261QP2000X | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | Group - Multi-Specialty |
| No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | Group - Multi-Specialty |
| No | 261QX0100X | Ambulatory Health Care Facilities | Clinic/Center | Occupational Medicine | |
| No | 273R00000X | Hospital Units | Psychiatric Unit | ||
| No | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | Group - Multi-Specialty | |
| No | 3416A0800X | Transportation Services | Ambulance | Air Transport |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| AK | 1005604 | Medicaid | |
| AK | DDG222 | Medicaid | |
| AK | MDG632 | Medicaid | |
| AK | MDG633 | Medicaid | |
| AK | HA9710 | Medicaid | |
| AK | HS-08-OP | Medicaid | |
| AK | HS-08-AS | Medicaid | |
| AK | HS-08-IP | Medicaid | |
| AK | MS6274 | Medicaid | |
| AK | PH7403 | Medicaid | |
| AK | AA6274 | Medicaid | |
| AK | MDG627 | Medicaid | |
| AK | 70206 | Other | BUSINESS LICENSE |
| AK | HS-08-AS | Medicaid |
