Provider Demographics
NPI:1447622485
Name:ANCHORAGE SLEEP CENTER, LLC
Entity type:Organization
Organization Name:ANCHORAGE SLEEP CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:D
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-743-0050
Mailing Address - Street 1:510 W TUDOR RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-6649
Mailing Address - Country:US
Mailing Address - Phone:907-743-0050
Mailing Address - Fax:907-743-0060
Practice Address - Street 1:8800 GLACIER HWY
Practice Address - Street 2:SUITE 215
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8079
Practice Address - Country:US
Practice Address - Phone:907-500-7368
Practice Address - Fax:907-500-7386
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANCHORAGE SLEEP CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-29
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1026522261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1026522OtherAK BUSINESS LICENSE