Sud/bh 1115- Icm | |
400 W Benson Blvd Anchorage AK 99503-3829 | |
(907) 729-5418 | |
(907) 729-8607 |
Full Name | Sud/bh 1115- Icm |
---|---|
Speciality | Community/behavioral Health |
Location | 400 W Benson Blvd, Anchorage, Alaska |
Authorized Official Name and Position | Ronald Lee Olson (EXECUTIVE VICE PRESIDENT FINANCE) |
Authorized Official Contact | 9077294939 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Sud/bh 1115- Icm Po Box 35198 Seattle WA 98124-5198 Ph: () - | Sud/bh 1115- Icm 400 W Benson Blvd Anchorage AK 99503-3829 Ph: (907) 729-5418 |
NPI Number | 1275186975 |
---|---|
Provider Enumeration Date | 07/22/2019 |
Last Update Date | 08/31/2023 |
Certification Date | 08/31/2023 |
Identifier | Type | State | Issuer |
---|---|---|---|
1275186975 | NPI | - | NPPES |
1696879 | Medicaid | AK |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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