Provider Demographics
NPI:1114611456
Name:RBS EVOLUTION OF ALASKA LLC
Entity Type:Organization
Organization Name:RBS EVOLUTION OF ALASKA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:HALLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-212-3186
Mailing Address - Street 1:1044 JACKSON FELTS RD
Mailing Address - Street 2:
Mailing Address - City:JOELTON
Mailing Address - State:TN
Mailing Address - Zip Code:37080-4839
Mailing Address - Country:US
Mailing Address - Phone:629-216-3114
Mailing Address - Fax:
Practice Address - Street 1:188 W NORTHERN LIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3902
Practice Address - Country:US
Practice Address - Phone:907-562-2002
Practice Address - Fax:907-308-6947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty