Provider Demographics
NPI:1942729991
Name:STUDIO HEALTH OF ALASKA, LLC
Entity Type:Organization
Organization Name:STUDIO HEALTH OF ALASKA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:REBARCAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-302-1102
Mailing Address - Street 1:1315 MACOM DR STE 205
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-9361
Mailing Address - Country:US
Mailing Address - Phone:331-256-5444
Mailing Address - Fax:
Practice Address - Street 1:6711 DEBARR RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1803
Practice Address - Country:US
Practice Address - Phone:907-333-6525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-11
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty