Provider Demographics
NPI:1033305875
Name:FAMILY MEDICINE OF ALASKA INC
Entity Type:Organization
Organization Name:FAMILY MEDICINE OF ALASKA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAJCSAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-376-1276
Mailing Address - Street 1:1261 S SEWARD MERIDIAN PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-8334
Mailing Address - Country:US
Mailing Address - Phone:907-376-1276
Mailing Address - Fax:907-373-0755
Practice Address - Street 1:1261 S SEWARD MERIDIAN PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8334
Practice Address - Country:US
Practice Address - Phone:907-376-1276
Practice Address - Fax:907-373-0755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD15371Medicaid
AKMD15371Medicaid