Provider Demographics
NPI:1629215488
Name:ORTHOPAEDIC SURGICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:ORTHOPAEDIC SURGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:TAMAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-374-6602
Mailing Address - Street 1:1917 ABBOTT RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-3448
Mailing Address - Country:US
Mailing Address - Phone:907-770-3202
Mailing Address - Fax:907-770-3287
Practice Address - Street 1:1275 SADLER WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-3171
Practice Address - Country:US
Practice Address - Phone:907-374-6602
Practice Address - Fax:907-374-6604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3104207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty