Provider Demographics
NPI:1689773186
Name:BURKE IVERSEN INC
Entity Type:Organization
Organization Name:BURKE IVERSEN INC
Other - Org Name:ALASKA FAMILY MEDICINE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LIDDLE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:907-743-1435
Mailing Address - Street 1:2841 DEBARR RD
Mailing Address - Street 2:SUITE 40
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2932
Mailing Address - Country:US
Mailing Address - Phone:907-743-1435
Mailing Address - Fax:907-743-1400
Practice Address - Street 1:2841 DEBARR RD
Practice Address - Street 2:SUITE 40
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2932
Practice Address - Country:US
Practice Address - Phone:907-743-1435
Practice Address - Fax:907-743-1400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK279762207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKGR0150Medicaid
AKK OOOOWCKDWMedicare PIN
AKGR0150Medicaid