NPIMap

Organization Active NPI

Petersburg Borough

  • Land Ambulance
  • Petersburg, AK
National Provider Identifier
1689721144
Registry record updated Apr 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Land AmbulanceTaxonomy code 3416L0300X
License
5005 Issued in AK
Legal business name
PETERSBURG BOROUGH
Practice address
1200 Haugen Drive
Petersburg, AK 99833
Phone
(907) 772-3355
NPI assigned
Jan 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2013

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

Authorized official

Name
Jody Tow
Title
Finance Director
Phone
(907) 772-4425

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Land Ambulance 3416L0300X 5005 AK Primary

Addresses

Primary practice location

1200 Haugen Drive
Petersburg, AK 99833

Mailing address

PO Box 329
Petersburg, AK 99833-0329
Phone (907) 772-4425

Other identifiers 1

IdentifierTypeStateIssuer
GA5005MedicaidAK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100518000323 AK Part B Supplier - Ambulance Service Supplier 8820126519 Practice locations: Petersburg, AK

National Provider Directory

National Provider Directory
Tax ID family
Petersburg Borough2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366070400000",
    "number": "1689721144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 329",
            "city": "PETERSBURG",
            "state": "AK",
            "postal_code": "998330329",
            "telephone_number": "907-772-4425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 HAUGEN DRIVE",
            "city": "PETERSBURG",
            "state": "AK",
            "postal_code": "99833",
            "telephone_number": "907-772-3355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSBURG BOROUGH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-05",
        "last_updated": "2013-04-16",
        "status": "A",
        "authorized_official_last_name": "TOW",
        "authorized_official_first_name": "JODY",
        "authorized_official_title_or_position": "FINANCE DIRECTOR",
        "authorized_official_telephone_number": "907-772-4425"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "AK",
            "license": "5005",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GA5005",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Petersburg, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.