Provider Demographics
NPI:1205035573
Name:WHITE SKYE SUMMIT LLC
Entity Type:Organization
Organization Name:WHITE SKYE SUMMIT LLC
Other - Org Name:ARCTIC SKYE FAMILY MEDICIME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:SC
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-745-7944
Mailing Address - Street 1:561 S DENALI
Mailing Address - Street 2:SUITE E
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645
Mailing Address - Country:US
Mailing Address - Phone:907-745-7944
Mailing Address - Fax:907-745-7918
Practice Address - Street 1:561 S DENALI
Practice Address - Street 2:SUITE E
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645
Practice Address - Country:US
Practice Address - Phone:907-745-7944
Practice Address - Fax:907-745-7944
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHITE SKYE SUMMIT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-16
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2726207Q00000X
AK903568261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatricGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK2726OtherSTATE LICENSE