ALASKA KIDNEY & DIABETES ASSOCIATION NPI 1619935558

NPI Information

NPI: 1619935558
Provider Name: ALASKA KIDNEY & DIABETES ASSOCIATION

Other Name: BONGO MEDICAL

Classification: Internal Medicine - 207RE0101X
Entity Type: Organization

Specialization: Endocrinology, Diabetes & Metabolism

CLIA Number: 02D2058715

Address:
3260 PROVIDENCE DR
#523
ANCHORAGE, AK
ZIP 99508
Phone: (907) 569-1049
Get Directions

ALASKA KIDNEY & DIABETES ASSOCIATION is an endocrinology and diabetes and metabolism internal medicine in Anchorage, AK. The provider is an internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, obesity, pituitary diseases and menstrual and sexual problems. ALASKA KIDNEY & DIABETES ASSOCIATION NPI is 1619935558. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Other Name Is Bongo Medical.

The provider's business location address is:

3260 PROVIDENCE DR
#523
ANCHORAGE, AK
ZIP 99508-608
Phone: (907) 569-1049
Fax: (907) 563-4564

The provider's authorized official is Leslie A. Glasgow .
The authorized official title is Ceo and has the following contact phone number (907) 569-1049.

The CLIA number assigned to this NPI record is 02D2058715 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/2/2006 and was last updated on 1/3/2013.

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
1	207RN0300X	Internal Medicine	Nephrology			No
2	207RE0101X	Internal Medicine	Endocrinology, Diabetes & Metabolism			Yes

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
1	K152825	MEDICARE PIN	ALASKA

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: 11/14/2023

NPI Synchronization or Removal

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