Provider Demographics
NPI:1972596633
Name:AA PAIN CLINIC, INC.
Entity Type:Organization
Organization Name:AA PAIN CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEON
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-563-2873
Mailing Address - Street 1:PO BOX 202113
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99520-2113
Mailing Address - Country:US
Mailing Address - Phone:907-929-8704
Mailing Address - Fax:907-929-8744
Practice Address - Street 1:4100 LAKE OTIS PKWY
Practice Address - Street 2:SUITE 216
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5222
Practice Address - Country:US
Practice Address - Phone:907-563-2873
Practice Address - Fax:907-563-5852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMDG444Medicaid
AK0000WGBBGMedicare ID - Type UnspecifiedNORIDIAN MEDICARE