| |
307 E Northern Lights Blvd Ste 101 Anchorage AK 99503-2701 | |
(907) 865-3247 | |
(833) 992-2022 |
Full Name | |
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Speciality | Clinic/Center |
Location | 307 E Northern Lights Blvd Ste 101, Anchorage, Alaska |
Authorized Official Name and Position | Lynn Murphy (OPERATIONS DIRECTOR) |
Authorized Official Contact | 9079294528 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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801 W Fireweed Ln Ste 103 Anchorage AK 99503-1893 Ph: (452) 890-7929 | 307 E Northern Lights Blvd Ste 101 Anchorage AK 99503-2701 Ph: (907) 865-3247 |
NPI Number | 1225633449 |
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Provider Enumeration Date | 12/04/2020 |
Last Update Date | 03/11/2022 |
Medicare PECOS PAC ID | 5395150460 |
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Medicare Enrollment ID | O20210223001828 |
Identifier | Type | State | Issuer |
---|---|---|---|
1225633449 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
Provider Name | Tracey Lauren Wiese |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1467781021 PECOS PAC ID: 7315075843 Enrollment ID: I20100504000715 |
Provider Name | Crystal J Beal |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1609130723 PECOS PAC ID: 5991025017 Enrollment ID: I20200512003702 |
Provider Name | Monica Holloway Perez-verdia |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1508316324 PECOS PAC ID: 4587083373 Enrollment ID: I20200928003069 |
Provider Name | Jennifer Talley |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1699498055 PECOS PAC ID: 3779946280 Enrollment ID: I20230831001555 |
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