| Pure Healthcare Of Alaska Llc | |
|
4200 Lake Otis Pkwy Ste 301 Anchorage AK 99508-5226 | |
| (907) 318-9300 | |
| (907) 416-6961 |
| Full Name | Pure Healthcare Of Alaska Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4200 Lake Otis Pkwy Ste 301, Anchorage, Alaska |
| Authorized Official Name and Position | Joshua T Tandy (DIRECTOR) |
| Authorized Official Contact | 8015909267 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pure Healthcare Of Alaska Llc 4179 S Riverboat Rd Ste 220 Taylorsville UT 84123-2986 Ph: (801) 590-9267 | Pure Healthcare Of Alaska Llc 4200 Lake Otis Pkwy Ste 301 Anchorage AK 99508-5226 Ph: (907) 318-9300 |
| NPI Number | 1962100727 |
|---|---|
| Provider Enumeration Date | 02/21/2023 |
| Last Update Date | 05/26/2023 |
| Medicare PECOS PAC ID | 7810358934 |
|---|---|
| Medicare Enrollment ID | O20230804000986 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962100727 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Jared John Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659860724 PECOS PAC ID: 1951634641 Enrollment ID: I20210921000725 |
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