Provider Demographics
NPI:1023897485
Name:MCKINLEY CARE MEDICAL SUPPLIES
Entity type:Organization
Organization Name:MCKINLEY CARE MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:M
Authorized Official - Last Name:POMERANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-206-1200
Mailing Address - Street 1:4311 CONSTELLATION AVE UNIT G53
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-2735
Mailing Address - Country:US
Mailing Address - Phone:907-206-1200
Mailing Address - Fax:907-802-4374
Practice Address - Street 1:337 E 4TH AVE UNIT B
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-2664
Practice Address - Country:US
Practice Address - Phone:907-268-6576
Practice Address - Fax:907-802-4374
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCKINLEY CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies