Provider Demographics
NPI:1912357286
Name:DENALI ASTHMA & PULMONARY LLC
Entity Type:Organization
Organization Name:DENALI ASTHMA & PULMONARY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHOTWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-824-4412
Mailing Address - Street 1:351 W PARKS HWY
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6920
Mailing Address - Country:US
Mailing Address - Phone:907-357-8483
Mailing Address - Fax:
Practice Address - Street 1:351 W PARKS HWY
Practice Address - Street 2:SUITE 100A
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6920
Practice Address - Country:US
Practice Address - Phone:907-357-8483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKK166616Medicare PIN