| Organization Name: | ANCHORAGE SLEEP CENTER, LLC DBA KODIAK SLEEP CENTER |
| NPI Number: | 1154739878 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CAMERON DEAN GARDNER (MANAGING MEMBER) |
| Mailing Address: | 104 Center Ave Suite 102 Kodiak |
| State: | AK US |
| Postal Code: | 996156393 |
| Phone Number: | 9075122060 |
| Fax Number: | 9075122070 |
| NPI Enumeration Date: | 07/25/2014 |
| NPI Last Update Date: | 07/25/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QS1200X |
| License Number: | 1008468 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AK |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Sleep Disorder Diagnostic |
| Taxonomy Definition: | |