Provider Demographics
NPI:1477029767
Name:PACIFIC PEDIATRICS, LLC
Entity Type:Organization
Organization Name:PACIFIC PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ROSIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-300-8189
Mailing Address - Street 1:PO BOX 181
Mailing Address - Street 2:
Mailing Address - City:CRAIG
Mailing Address - State:AK
Mailing Address - Zip Code:99921-0181
Mailing Address - Country:US
Mailing Address - Phone:313-300-8189
Mailing Address - Fax:833-887-4972
Practice Address - Street 1:602 JS ST
Practice Address - Street 2:UNIT#1
Practice Address - City:CRAIG
Practice Address - State:AK
Practice Address - Zip Code:99921-9992
Practice Address - Country:US
Practice Address - Phone:313-300-8189
Practice Address - Fax:833-887-4972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-15
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1009328Medicaid