Provider Demographics
NPI:1073872669
Name:LYNX MEDICAL SERVICES ORGANIZATION
Entity Type:Organization
Organization Name:LYNX MEDICAL SERVICES ORGANIZATION
Other - Org Name:ALASKA VEIN CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CRANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-909-5866
Mailing Address - Street 1:777 E 2100 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-1829
Mailing Address - Country:US
Mailing Address - Phone:800-909-5866
Mailing Address - Fax:801-665-1882
Practice Address - Street 1:3066 E MERIDIAN PARK LOOP
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7299
Practice Address - Country:US
Practice Address - Phone:907-357-2005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Single Specialty