Provider Demographics
NPI:1275983546
Name:DENALI ASTHMA & PULMONARY
Entity Type:Organization
Organization Name:DENALI ASTHMA & PULMONARY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOTWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-824-4412
Mailing Address - Street 1:35670 KENAI SPUR HWY
Mailing Address - Street 2:SUITE 103B
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7649
Mailing Address - Country:US
Mailing Address - Phone:907-260-9515
Mailing Address - Fax:907-260-9510
Practice Address - Street 1:35670 KENAI SPUR HWY
Practice Address - Street 2:SUITE 103B
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7649
Practice Address - Country:US
Practice Address - Phone:907-260-9515
Practice Address - Fax:907-260-9510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKK166616Medicare PIN