Provider Demographics
NPI:1275591018
Name:FAMILY PRACTICE PHYSICIANS INC
Entity Type:Organization
Organization Name:FAMILY PRACTICE PHYSICIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:9007-789-2910
Mailing Address - Street 1:10301 GLACIER HWY
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-8561
Mailing Address - Country:US
Mailing Address - Phone:907-789-2910
Mailing Address - Fax:907-789-5545
Practice Address - Street 1:10301 GLACIER HWY
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8561
Practice Address - Country:US
Practice Address - Phone:907-789-2910
Practice Address - Fax:907-789-5545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKGR0136Medicaid
AKGR0136Medicaid