Provider Demographics
NPI:1366640070
Name:RAYMOND E. ANDREASSEN
Entity Type:Organization
Organization Name:RAYMOND E. ANDREASSEN
Other - Org Name:FAMILY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:907-895-5100
Mailing Address - Street 1:HC 60 BOX 4860
Mailing Address - Street 2:
Mailing Address - City:DELTA JUNCTION
Mailing Address - State:AK
Mailing Address - Zip Code:99737-9440
Mailing Address - Country:US
Mailing Address - Phone:907-895-5100
Mailing Address - Fax:907-895-5133
Practice Address - Street 1:2360 SERVICE STREET
Practice Address - Street 2:
Practice Address - City:DELTA JUNCTION
Practice Address - State:AK
Practice Address - Zip Code:99737-9440
Practice Address - Country:US
Practice Address - Phone:907-895-5100
Practice Address - Fax:907-895-5133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA 2011207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD 9969Medicaid
AKMD 9969Medicaid