Provider Demographics
NPI:1588805048
Name:HEALTH NORTH FAMILY MEDICINE LLC
Entity type:Organization
Organization Name:HEALTH NORTH FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROD
Authorized Official - Middle Name:A
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:907-260-7729
Mailing Address - Street 1:34924 STERLING HIGHWAY
Mailing Address - Street 2:BUILDING B
Mailing Address - City:STERLING
Mailing Address - State:AK
Mailing Address - Zip Code:99672
Mailing Address - Country:US
Mailing Address - Phone:907-260-7729
Mailing Address - Fax:
Practice Address - Street 1:34924 STERLING HIGHWAY
Practice Address - Street 2:BUILDING B
Practice Address - City:STERLING
Practice Address - State:AK
Practice Address - Zip Code:99672
Practice Address - Country:US
Practice Address - Phone:907-260-7729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-13
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK927322207Q00000X
AK4349AK261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty