1871754473 NPI number — LIFEMED ALASKA, LLC

Table of content: (NPI 1871754473)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871754473 NPI number — LIFEMED ALASKA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFEMED ALASKA, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871754473
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6320 S AIRPARK PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99502-1865
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-563-6633
Provider Business Mailing Address Fax Number:
907-563-6636

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6320 S AIRPARK PL
Provider Second Line Business Practice Location Address:
HANGAR #1 AND #2
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99502-1865
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-563-6633
Provider Business Practice Location Address Fax Number:
907-563-6636
Provider Enumeration Date:
06/17/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KIRBY
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
907-249-8451

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  4300 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3416A0800X , with the licence number: 915056 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416A0800X , with the licence number: 6300 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416A0800X , with the licence number: 9300 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416A0800X , with the licence number: 4300 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , with the licence number: 3300 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , with the licence number: 3200 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , with the licence number: 3305 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , with the licence number: 3220 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: HC8626 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: K165057 . This is a "PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA6300 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: TX6224 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: GA6320 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: K161982 . This is a "PTAN" identifier . This identifiers is of the category "OTHER".