| Sra D.o. Llc | |
|
2530 Debarr Rd Anchorage AK 99508-2948 | |
| (907) 258-7575 | |
| (907) 561-7464 |
| Full Name | Sra D.o. Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2530 Debarr Rd, Anchorage, Alaska |
| Authorized Official Name and Position | Spencer Richard Augustin (PRESIDENT) |
| Authorized Official Contact | 9075290103 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sra D.o. Llc Po Box 241889 Anchorage AK 99524-1889 Ph: (907) 563-1777 | Sra D.o. Llc 2530 Debarr Rd Anchorage AK 99508-2948 Ph: (907) 258-7575 |
| NPI Number | 1164166088 |
|---|---|
| Provider Enumeration Date | 04/26/2022 |
| Last Update Date | 08/23/2022 |
| Certification Date | 08/23/2022 |
| Medicare PECOS PAC ID | 5799164836 |
|---|---|
| Medicare Enrollment ID | O20220621002563 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164166088 | NPI | - | NPPES |
| 1730694 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Spencer Richard Augustin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1366963381 PECOS PAC ID: 9234553892 Enrollment ID: I20220623002952 |
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