| Sud 1115- Pcc | |
|
4320 Diplomacy Dr Anchorage AK 99508-5925 | |
| (907) 729-3300 | |
| Not Available |
| Full Name | Sud 1115- Pcc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4320 Diplomacy Dr, 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 1115- Pcc Po Box 35198 Seattle WA 98124-5198 Ph: () - | Sud 1115- Pcc 4320 Diplomacy Dr Anchorage AK 99508-5925 Ph: (907) 729-3300 |
| NPI Number | 1306499710 |
|---|---|
| Provider Enumeration Date | 07/24/2019 |
| Last Update Date | 08/31/2023 |
| Certification Date | 08/31/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306499710 | NPI | - | NPPES |
| 1696889 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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