Provider Demographics
NPI:1760691612
Name:ORTHOPAEDIC RESEARCH CLINIC OF ALASKA INC
Entity Type:Organization
Organization Name:ORTHOPAEDIC RESEARCH CLINIC OF ALASKA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-644-6055
Mailing Address - Street 1:2741 DEBARR RD
Mailing Address - Street 2:SUITE C-214
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2953
Mailing Address - Country:US
Mailing Address - Phone:907-644-6055
Mailing Address - Fax:907-644-4885
Practice Address - Street 1:2741 DEBARR RD
Practice Address - Street 2:SUITE C-214
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-644-6055
Practice Address - Fax:907-644-4885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK904974207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty