| Medical Park Family Care, Llc | |
|
2211 E Northern Lights Blvd Anchorage AK 99508-4103 | |
| (907) 257-8486 | |
| (907) 677-5614 |
| Full Name | Medical Park Family Care, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 2211 E Northern Lights Blvd, Anchorage, Alaska |
| Authorized Official Name and Position | Joseph Fong (ADMINISTRATOR) |
| Authorized Official Contact | 9072578121 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Medical Park Family Care, Llc 2211 E Northern Lights Blvd Anchorage AK 99508 Ph: (907) 279-8486 | Medical Park Family Care, Llc 2211 E Northern Lights Blvd Anchorage AK 99508-4103 Ph: (907) 257-8486 |
| NPI Number | 1144392317 |
|---|---|
| Provider Enumeration Date | 11/14/2006 |
| Last Update Date | 07/25/2024 |
| Medicare PECOS PAC ID | 9638161268 |
|---|---|
| Medicare Enrollment ID | O20040401001357 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144392317 | NPI | - | NPPES |
| KOOOOWCHKZ | Other | AK | MEDICARE |
| 02D0864632 | Other | AK | CLIA |
| 1004348 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Andrew Moran |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1619077476 PECOS PAC ID: 6406755107 Enrollment ID: I20031231000672 |
| Provider Name | Harold F Cable |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1629049762 PECOS PAC ID: 1052382678 Enrollment ID: I20050829000654 |
| Provider Name | John J Mccormick |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1144291295 PECOS PAC ID: 9335110956 Enrollment ID: I20050829000668 |
| Provider Name | David G Davenport |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1174511919 PECOS PAC ID: 5294834156 Enrollment ID: I20070619000355 |
| Provider Name | Dirk C Bringhurst |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1609865948 PECOS PAC ID: 0345323408 Enrollment ID: I20080212000620 |
| Provider Name | David Madden |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1518905413 PECOS PAC ID: 4284737800 Enrollment ID: I20080605000903 |
| Provider Name | Jill E Gaskill |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174620181 PECOS PAC ID: 6608947957 Enrollment ID: I20080614000052 |
| Provider Name | Roy M White |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023180114 PECOS PAC ID: 3375722416 Enrollment ID: I20110121000590 |
| Provider Name | Timothy N Laufer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568534691 PECOS PAC ID: 1456530591 Enrollment ID: I20110121000603 |
| Provider Name | Kelly Powers |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1992923155 PECOS PAC ID: 1759433238 Enrollment ID: I20110221000688 |
| Provider Name | Julee K. Holayter |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1972538445 PECOS PAC ID: 7214017573 Enrollment ID: I20111018000830 |
| Provider Name | Lawrence P. Wood |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1861509333 PECOS PAC ID: 5496835753 Enrollment ID: I20111109000759 |
| Provider Name | Peter J Montesano |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093845281 PECOS PAC ID: 5294832085 Enrollment ID: I20120123000726 |
| Provider Name | Doron Ben Avi |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1003846379 PECOS PAC ID: 1355346800 Enrollment ID: I20120803000635 |
| Provider Name | Timothy W Miller |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326275082 PECOS PAC ID: 3274787932 Enrollment ID: I20140102001615 |
| Provider Name | Chris Glenn |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1457315533 PECOS PAC ID: 4385720317 Enrollment ID: I20150520000126 |
| Provider Name | Jason R Savikko |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1649504267 PECOS PAC ID: 1355650474 Enrollment ID: I20151012001162 |
| Provider Name | Matthew Cronin |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1821103714 PECOS PAC ID: 5890937395 Enrollment ID: I20170418002867 |
| Provider Name | Eric W Tuers |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093735813 PECOS PAC ID: 4880636570 Enrollment ID: I20190205003424 |
| Provider Name | Christopher S Coon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386206399 PECOS PAC ID: 6507192762 Enrollment ID: I20190725000888 |
| Provider Name | Wanatsanan Somkanay |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760040711 PECOS PAC ID: 0042546160 Enrollment ID: I20190728000022 |
| Provider Name | Peggy E Jesse |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790811057 PECOS PAC ID: 4880629872 Enrollment ID: I20190808001783 |
| Provider Name | Scott A Harman |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1124071311 PECOS PAC ID: 2062472798 Enrollment ID: I20190828002048 |
| Provider Name | Zachary M Buck |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871023135 PECOS PAC ID: 3577832302 Enrollment ID: I20200625003258 |
| Provider Name | William Perry |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1033557418 PECOS PAC ID: 0749516458 Enrollment ID: I20200729001484 |
| Provider Name | John Lubisich |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1194863902 PECOS PAC ID: 1557331816 Enrollment ID: I20200908001501 |
| Provider Name | Daniel Andrew Davignon |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1851624449 PECOS PAC ID: 2466885629 Enrollment ID: I20200928003003 |
| Provider Name | Rajiv Girish Rao |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1548603574 PECOS PAC ID: 2163756594 Enrollment ID: I20220614001635 |
| Provider Name | Daniel Mejia |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265993679 PECOS PAC ID: 5395111496 Enrollment ID: I20221014000484 |
| Provider Name | William R Harjes |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1760862155 PECOS PAC ID: 2163841743 Enrollment ID: I20221202002486 |
| Provider Name | Julie Ann Sweetin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326770405 PECOS PAC ID: 2961872635 Enrollment ID: I20230113002145 |
| Provider Name | Christian S Welch |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1669791844 PECOS PAC ID: 5799006953 Enrollment ID: I20230816002402 |
| Provider Name | Danash Raja |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427678614 PECOS PAC ID: 5799108965 Enrollment ID: I20231017003255 |
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