Organization
SOUTHCENTRALFOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOUGLAS EBY MD (VICE PRSIDENT MEDICAL SERVICES)
(907) 729-4955
Entity
Organization
Contact information
Practice address
4320 DIPLOMACY DR, ANCHORAGE, AK 99508-5925
(907) 729-4955
Mailing address
4320 DIPLOMACY DR, ANCHORAGE, AK 99508-5925
(907) 729-4955
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
10662
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10662
STATE OF ALASKA REGISTERED NURSE
AK
Enumeration date
08/04/2008
Last updated
08/04/2008
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