Provider Demographics
NPI:1134739485
Name:ALCAN MEDICAL GROUP LLC
Entity type:Organization
Organization Name:ALCAN MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BLOOD
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:907-328-0844
Mailing Address - Street 1:751 OLD RICHARDSON HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-7802
Mailing Address - Country:US
Mailing Address - Phone:907-328-0844
Mailing Address - Fax:907-328-0843
Practice Address - Street 1:751 OLD RICHARDSON HWY STE 203
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-7805
Practice Address - Country:US
Practice Address - Phone:303-472-6424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight ManagementGroup - Multi-Specialty