Provider Demographics
NPI:1497118574
Name:ANCHORAGE HOUSECALL MEDICINE LLC
Entity Type:Organization
Organization Name:ANCHORAGE HOUSECALL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:WINCZURA
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:907-622-4663
Mailing Address - Street 1:1444 S CREEK RD
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-9461
Mailing Address - Country:US
Mailing Address - Phone:907-622-4663
Mailing Address - Fax:907-622-4643
Practice Address - Street 1:1444 S CREEK RD
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-9461
Practice Address - Country:US
Practice Address - Phone:907-622-4663
Practice Address - Fax:907-622-4643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1032371261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMDA0160Medicaid
AKK161600Medicare PIN