Provider Demographics
NPI:1558749903
Name:ATP MEDICINE, LTD
Entity Type:Organization
Organization Name:ATP MEDICINE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-868-2961
Mailing Address - Street 1:2000 W. INTERNATIONAL RD
Mailing Address - Street 2:BUILDING B SUITE B4
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502
Mailing Address - Country:US
Mailing Address - Phone:907-868-2961
Mailing Address - Fax:
Practice Address - Street 1:2000 W. INTERNATIONAL RD
Practice Address - Street 2:BUILDING B SUITE B4
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-9992
Practice Address - Country:US
Practice Address - Phone:907-868-2961
Practice Address - Fax:907-868-2962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK977363261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center