Provider Demographics
NPI:1144601741
Name:DENAPOLI ORTHOPEDIC CARE, LLC
Entity Type:Organization
Organization Name:DENAPOLI ORTHOPEDIC CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DENAPOLI
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:907-347-8427
Mailing Address - Street 1:3419 AIRPORT WAY
Mailing Address - Street 2:SUITE D
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-4761
Mailing Address - Country:US
Mailing Address - Phone:907-328-2273
Mailing Address - Fax:907-328-2276
Practice Address - Street 1:3419 AIRPORT WAY
Practice Address - Street 2:SUITE D
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-4761
Practice Address - Country:US
Practice Address - Phone:907-328-2273
Practice Address - Fax:907-328-2276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1019666261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMDA0141Medicaid
AKMDA0141Medicaid