Provider Demographics
NPI:1326306150
Name:ADVENTURES IN PEDIATRICS, LLC
Entity Type:Organization
Organization Name:ADVENTURES IN PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:IMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:907-373-7337
Mailing Address - Street 1:3719 E MERIDIAN LOOP
Mailing Address - Street 2:SUITE D
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7273
Mailing Address - Country:US
Mailing Address - Phone:907-373-7337
Mailing Address - Fax:907-357-9029
Practice Address - Street 1:3719 E MERIDIAN LOOP
Practice Address - Street 2:SUITE D
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7273
Practice Address - Country:US
Practice Address - Phone:907-373-7337
Practice Address - Fax:907-357-9029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4300208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD10661Medicaid