Provider Demographics
NPI:1851829782
Name:DENALI HEALTHCARE SPECIALISTS LLC
Entity Type:Organization
Organization Name:DENALI HEALTHCARE SPECIALISTS LLC
Other - Org Name:DENALI CENTERS FOR NEUROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING DEPT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-398-8736
Mailing Address - Street 1:2421 E TUDOR RD STE 103
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1166
Mailing Address - Country:US
Mailing Address - Phone:907-770-5864
Mailing Address - Fax:907-770-5868
Practice Address - Street 1:2421 E TUDOR RD STE 103
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1166
Practice Address - Country:US
Practice Address - Phone:907-770-5864
Practice Address - Fax:907-770-5868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-23
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1677051Medicaid