Provider Demographics
NPI:1255675195
Name:LASER PRECISION SPINE SURGERY LLC
Entity Type:Organization
Organization Name:LASER PRECISION SPINE SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-677-8737
Mailing Address - Street 1:1200 AIRPORT HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2965
Mailing Address - Country:US
Mailing Address - Phone:907-677-8737
Mailing Address - Fax:907-677-9731
Practice Address - Street 1:1200 AIRPORT HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2965
Practice Address - Country:US
Practice Address - Phone:907-677-8737
Practice Address - Fax:907-677-9731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKS5446207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD6398Medicaid
AKD24838Medicare UPIN
AK1578588901Medicare PIN