Provider Demographics
NPI:1174890826
Name:MEGLITSCH, COLIN
Entity type:Individual
Prefix:
First Name:COLIN
Middle Name:
Last Name:MEGLITSCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 TUDOR CENTRE DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5904
Mailing Address - Country:US
Mailing Address - Phone:907-729-6350
Mailing Address - Fax:907-729-8607
Practice Address - Street 1:10 TAKOTNA AVE
Practice Address - Street 2:
Practice Address - City:MCGRATH
Practice Address - State:AK
Practice Address - Zip Code:99627
Practice Address - Country:US
Practice Address - Phone:907-729-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-23
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMDH0158Medicaid