Provider Demographics
NPI:1922648690
Name:ACHIEVE MEDICAL ALASKA LLC
Entity Type:Organization
Organization Name:ACHIEVE MEDICAL ALASKA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:WEATHERFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-540-3328
Mailing Address - Street 1:PO BOX 601453
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92160-1453
Mailing Address - Country:US
Mailing Address - Phone:619-540-3328
Mailing Address - Fax:619-383-6701
Practice Address - Street 1:1981 E PALMER
Practice Address - Street 2:SUITE 230
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:619-383-6700
Practice Address - Fax:619-383-6701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty