Provider Demographics
NPI:1538164223
Name:ANCHORAGE MEDICAL & SURGICAL CLINIC LLC
Entity type:Organization
Organization Name:ANCHORAGE MEDICAL & SURGICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:HORACE
Authorized Official - Last Name:RAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-272-2571
Mailing Address - Street 1:718 K STREET
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-3396
Mailing Address - Country:US
Mailing Address - Phone:907-272-2571
Mailing Address - Fax:907-272-6751
Practice Address - Street 1:718 K STREET
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3396
Practice Address - Country:US
Practice Address - Phone:907-272-2571
Practice Address - Fax:907-272-6751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK411284207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKGR0112Medicaid
AKCD8969OtherRAILROAD MEDICARE NUMBER
AKCD8969OtherRAILROAD MEDICARE NUMBER