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SOUTHEAST UROLOGY CLINIC A PC NPI 1083715262


NPI Information

NPI: 1083715262
Provider Name: SOUTHEAST UROLOGY CLINIC A PC
Classification: Urology - 208800000X
Entity Type: Organization
Address:
3100 TONGASS AVE
KETCHIKAN, AK
ZIP 99901
Phone: (907) 225-1896
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SOUTHEAST UROLOGY CLINIC A PC is an urology in Ketchikan, AK. The provider is a urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. SOUTHEAST UROLOGY CLINIC A PC NPI is 1083715262. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3100 TONGASS AVE
KETCHIKAN, AK
ZIP 99901-746
Phone: (907) 225-1896
Fax: (360) 428-4377

The provider's authorized official is Eva M Samtmana .
The authorized official title is Aministrator and has the following contact phone number (360) 424-7991.

The enumeration date for this NPI number is 9/26/2006 and was last updated on 8/9/2010.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208800000XUrology121467ALASKAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1K0000WCGXXMEDICARE ID-TYPE UNSPECIFIEDALASKA
2GR0126MEDICAIDALASKA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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