Provider Demographics
NPI:1952654139
Name:SPINE CARE SPECIALISTS OF ALASKA LLC
Entity Type:Organization
Organization Name:SPINE CARE SPECIALISTS OF ALASKA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-456-3876
Mailing Address - Street 1:2310 PEGER RD
Mailing Address - Street 2:STE 106
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-5305
Mailing Address - Country:US
Mailing Address - Phone:907-456-3876
Mailing Address - Fax:907-456-3877
Practice Address - Street 1:2310 PEGER RD
Practice Address - Street 2:STE 106
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-5305
Practice Address - Country:US
Practice Address - Phone:907-456-3876
Practice Address - Fax:907-456-3877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty