Provider Demographics
NPI:1376213207
Name:ATLAS MEDICAL ALASKA LLC
Entity Type:Organization
Organization Name:ATLAS MEDICAL ALASKA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-215-4846
Mailing Address - Street 1:950 E BOGARD RD STE 228
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7185
Mailing Address - Country:US
Mailing Address - Phone:907-215-4846
Mailing Address - Fax:907-215-4847
Practice Address - Street 1:950 E BOGARD RD STE 228
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7185
Practice Address - Country:US
Practice Address - Phone:907-215-4846
Practice Address - Fax:907-215-4847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-13
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty