EAGLE RIVER PRIMARY CARE NPI 1235319450

NPI Information

NPI: 1235319450
Provider Name: EAGLE RIVER PRIMARY CARE

Doing Business As: EAGLE RIVER PRIMARY CARE, LLC

Classification: Physician Assistant - 363AM0700X
Entity Type: Organization

Specialization: Medical

Address:
11462 BUSINESS BLVD
EAGLE RIVER, AK
ZIP 99577
Phone: (907) 694-0770
Get Directions

EAGLE RIVER PRIMARY CARE is a medical physician assistant in Eagle River, AK. EAGLE RIVER PRIMARY CARE NPI is 1235319450. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Eagle River Primary Care, Llc.

The provider's business location address is:

11462 BUSINESS BLVD
EAGLE RIVER, AK
ZIP 99577-721
Phone: (907) 694-0770
Fax: (907) 694-1378

The provider's authorized official is Jennifer J Oxford .
The authorized official title is Registered Agent and has the following contact phone number (907) 694-0770.

The enumeration date for this NPI number is 11/5/2007 and was last updated on 5/21/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AM0700X	Physician Assistant	Medical	PA448	ALASKA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	$$$$$$$$$	OTHER	ALASKA	INDIVIDUAL SSN
2	1326187055	OTHER	ALASKA	INDIVIDUAL NPI
3	1407920085	OTHER	ALASKA	INDIVIDUAL NPI
4	MD57671	MEDICAID	ALASKA
5	MD42453	MEDICAID	ALASKA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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