Provider Demographics
NPI:1841270337
Name:U.S. HEALTHWORKS MEDICAL GROUP OF ALASKA, LLC
Entity type:Organization
Organization Name:U.S. HEALTHWORKS MEDICAL GROUP OF ALASKA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VP
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:T
Authorized Official - Last Name:MALLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-678-2600
Mailing Address - Street 1:25124 SPRINGFIELD COURT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1085
Mailing Address - Country:US
Mailing Address - Phone:661-678-2600
Mailing Address - Fax:661-678-2700
Practice Address - Street 1:25124 SPRINGFIELD CT
Practice Address - Street 2:SUITE 200
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-1085
Practice Address - Country:US
Practice Address - Phone:661-678-2600
Practice Address - Fax:661-678-2700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK209000701OtherDEPT. OF LABOR - PCA
AK209000702OtherDEPT. OF LABOR - EAGLE RI
AK02D0674243OtherCLIA - HUFFMAN CLINIC
AK209000700OtherDEPT. OF LABOR - LOUC
AKMDG269Medicaid
AKMDG2691Medicaid
AK02D0640776OtherCLIA - PCA
AK02D0943068OtherCLIA - EAGLE RIVER CLINIC
AK02D0991092OtherCLIA - LOUC
AK209000703OtherDEPT. OF LABOR - HUFFMAN
AKMDG2693Medicaid
AKMDG2692Medicaid
AKMDG2691Medicaid