Provider Demographics
NPI:1962572099
Name:JUNEAU FAMILY BIRTH CENTER
Entity type:Organization
Organization Name:JUNEAU FAMILY BIRTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAYE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KANNE
Authorized Official - Suffix:
Authorized Official - Credentials:CDM
Authorized Official - Phone:907-586-1203
Mailing Address - Street 1:3225 HOSPITAL DR UNIT 106
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-7863
Mailing Address - Country:US
Mailing Address - Phone:907-586-1203
Mailing Address - Fax:907-586-5765
Practice Address - Street 1:3225 HOSPITAL DR UNIT 106
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7863
Practice Address - Country:US
Practice Address - Phone:907-586-1203
Practice Address - Fax:907-586-5765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK160189Medicare ID - Type Unspecified