| Bsd-icm | |
|
400 W Benson Blvd Anchorage AK 99503-3829 | |
| (907) 729-2500 | |
| Not Available |
| Full Name | Bsd-icm |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 400 W Benson Blvd, Anchorage, Alaska |
| Authorized Official Name and Position | Ronald Lee Olson (EXECUTIVE VICE PRESIDENT FINANCE) |
| Authorized Official Contact | 9077294939 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bsd-icm Po Box 35198 Seattle WA 98124-5198 Ph: () - | Bsd-icm 400 W Benson Blvd Anchorage AK 99503-3829 Ph: (907) 729-2500 |
| NPI Number | 1750854089 |
|---|---|
| Provider Enumeration Date | 01/09/2019 |
| Last Update Date | 09/14/2023 |
| Certification Date | 09/14/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750854089 | NPI | - | NPPES |
| 1697415 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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