Provider Demographics
NPI:1679704688
Name:ACUTE FAMILY MEDICINE CLINIC INC
Entity Type:Organization
Organization Name:ACUTE FAMILY MEDICINE CLINIC INC
Other - Org Name:ALASKA HEALTHCARE ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:COVERDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-622-4325
Mailing Address - Street 1:11470 BUSINESS BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7780
Mailing Address - Country:US
Mailing Address - Phone:907-622-4325
Mailing Address - Fax:907-622-4326
Practice Address - Street 1:11470 BUSINESS BLVD
Practice Address - Street 2:STE 100
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7780
Practice Address - Country:US
Practice Address - Phone:907-622-4325
Practice Address - Fax:907-622-4326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4780207Q00000X
AK5172207Q00000X
AK44822207Q00000X
AK367363A00000X
AK2013363A00000X
AK739363A00000X
AK584363LF0000X
AK296363LF0000X
AK904363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD5172Medicaid
AKNPO904Medicaid
AK44822Medicaid
AKNPO2962Medicaid
AKMD6321Medicaid