Provider Demographics
NPI:1316015480
Name:ALASKA MEDICAL CLINICS, LLC
Entity Type:Organization
Organization Name:ALASKA MEDICAL CLINICS, LLC
Other - Org Name:WASILLA MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:MACLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-341-7714
Mailing Address - Street 1:1700 E PARKS HWY
Mailing Address - Street 2:#200
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7352
Mailing Address - Country:US
Mailing Address - Phone:907-373-6055
Mailing Address - Fax:907-373-6077
Practice Address - Street 1:1700 E PARKS HWY
Practice Address - Street 2:#200
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7352
Practice Address - Country:US
Practice Address - Phone:907-373-6055
Practice Address - Fax:907-373-6077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMDG016Medicaid
AKMDG017Medicaid