Provider Demographics
NPI:1841612132
Name:LAST FRONTIER NEUROSURGERY
Entity Type:Organization
Organization Name:LAST FRONTIER NEUROSURGERY
Other - Org Name:ARCTIC SPINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-222-6500
Mailing Address - Street 1:3650 LAKE OTIS PKWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5218
Mailing Address - Country:US
Mailing Address - Phone:907-222-6500
Mailing Address - Fax:907-222-6550
Practice Address - Street 1:3650 LAKE OTIS PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5218
Practice Address - Country:US
Practice Address - Phone:907-222-6500
Practice Address - Fax:907-222-6550
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARIUS MAXWELL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-06
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK7202174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty