Provider Demographics
NPI:1033898077
Name:WILLOWCREEK AK TRANSPORT INCORPORATED
Entity Type:Organization
Organization Name:WILLOWCREEK AK TRANSPORT INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-351-0569
Mailing Address - Street 1:19216 CITATION RD
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8416
Mailing Address - Country:US
Mailing Address - Phone:907-351-0569
Mailing Address - Fax:
Practice Address - Street 1:2060 BRIGADIER DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-5376
Practice Address - Country:US
Practice Address - Phone:907-351-0569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)