Provider Demographics
NPI:1558703199
Name:VEIN SPECIALISTS OF ALASKA LLC
Entity Type:Organization
Organization Name:VEIN SPECIALISTS OF ALASKA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:TY
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-631-3799
Mailing Address - Street 1:2521 E MOUNTAIN VILLAGE DR
Mailing Address - Street 2:SUITE B-437
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7373
Mailing Address - Country:US
Mailing Address - Phone:907-357-2005
Mailing Address - Fax:907-631-4132
Practice Address - Street 1:3035 E PALMER WASILLA HWY STE 601
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7279
Practice Address - Country:US
Practice Address - Phone:907-631-3799
Practice Address - Fax:907-631-4132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-24
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK6942202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK992407OtherAK STATE
AK992407OtherAK STATE