NPIMap

Organization Active NPI

Juneau Obstetrics and Gynecology, P.C.

  • Gynecology Physician
  • Juneau, AK
National Provider Identifier
1649362948
Registry record updated Jul 29, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
License
2531 Issued in AK
Legal business name
JUNEAU OBSTETRICS AND GYNECOLOGY, P.C.
Practice address
3268 Hospital Dr Ste B
Juneau, AK 99801-7800
Phone
(907) 586-1717
Fax
(907) 586-2677
NPI assigned
Sep 28, 2006
Last updated
Jul 29, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Nicholas D Newbury, D.O.NPI 1417214933
Title
Owner
Phone
(907) 586-1717

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology Physician 207VG0400X 2531 AK Primary

Addresses

Primary practice location

3268 Hospital Dr Ste B
Juneau, AK 99801-7800

Mailing address

3268 Hospital Dr Ste B
Juneau, AK 99801-7800
Phone (907) 586-1717

Other identifiers 2

IdentifierTypeStateIssuer
MD2531MedicaidAK
1020712MedicaidAK

Other names 1

  • Nell Ann Wagoner, M.D., P.C. Former legal business name

National Provider Directory

National Provider Directory

Locations

3268 Hospital Dr
Ste B
Juneau, AK 99801
Phone (907) 586-1717

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1501286400000",
    "number": "1649362948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3268 HOSPITAL DR STE B",
            "city": "JUNEAU",
            "state": "AK",
            "postal_code": "998017800",
            "telephone_number": "907-586-1717",
            "fax_number": "907-586-2677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3268 HOSPITAL DR STE B",
            "city": "JUNEAU",
            "state": "AK",
            "postal_code": "998017800",
            "telephone_number": "907-586-1717",
            "fax_number": "907-586-2677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUNEAU OBSTETRICS AND GYNECOLOGY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2017-07-29",
        "status": "A",
        "authorized_official_last_name": "NEWBURY",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "907-586-1717",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "AK",
            "license": "2531",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MD2531",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1020712",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nell Ann Wagoner, M.D., P.C.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Juneau, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.