Provider Demographics
NPI:1487786703
Name:ALASKA PODIATRY ASSOCIATES, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ALASKA PODIATRY ASSOCIATES, A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:SWAYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:907-562-4958
Mailing Address - Street 1:2741 DEBARR RD
Mailing Address - Street 2:SUITE C-315
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2953
Mailing Address - Country:US
Mailing Address - Phone:907-562-4958
Mailing Address - Fax:907-562-5195
Practice Address - Street 1:2741 DEBARR RD
Practice Address - Street 2:SUITE C-315
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2953
Practice Address - Country:US
Practice Address - Phone:907-562-4958
Practice Address - Fax:907-562-5195
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALASKA PODIATRY ASSOCIATES, A PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-12
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK196425213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPDG262Medicaid
AK0000WCNJXMedicare ID - Type UnspecifiedMEDICARE