Provider Demographics
NPI:1679571640
Name:HEALTH WORKS FAMILY MED CLINIC INC.
Entity Type:Organization
Organization Name:HEALTH WORKS FAMILY MED CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:EGBERT
Authorized Official - Suffix:
Authorized Official - Credentials:ADVANCED NP
Authorized Official - Phone:907-622-9675
Mailing Address - Street 1:12812 OLD GLENN HWY
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7003
Mailing Address - Country:US
Mailing Address - Phone:907-622-9675
Mailing Address - Fax:907-622-9676
Practice Address - Street 1:12812 OLD GLENN HWY
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7003
Practice Address - Country:US
Practice Address - Phone:907-622-9675
Practice Address - Fax:907-622-9676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK580363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P74292Medicare UPIN
K153066Medicare ID - Type Unspecified