Provider Demographics
NPI:1548723083
Name:BIRD, TASHA R
Entity type:Individual
Prefix:MISS
First Name:TASHA
Middle Name:R
Last Name:BIRD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:AK
Mailing Address - Zip Code:99658-0310
Mailing Address - Country:US
Mailing Address - Phone:907-438-3500
Mailing Address - Fax:907-438-3540
Practice Address - Street 1:310 HOSPITAL ROAD
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:AK
Practice Address - Zip Code:99658
Practice Address - Country:US
Practice Address - Phone:907-438-3500
Practice Address - Fax:907-438-3540
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1020986Medicaid