Provider Demographics
NPI:1255155180
Name:CONSTANCE JERZ LLC
Entity type:Organization
Organization Name:CONSTANCE JERZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:JERZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-205-9642
Mailing Address - Street 1:PO BOX 141556
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99514-1556
Mailing Address - Country:US
Mailing Address - Phone:907-205-9642
Mailing Address - Fax:
Practice Address - Street 1:2011 ABBOTT RD STE C
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-3422
Practice Address - Country:US
Practice Address - Phone:907-205-9642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service