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CAMELOT FAMILY HEALTH LLC NPI 1336685908


NPI Information

NPI: 1336685908
Provider Name: CAMELOT FAMILY HEALTH LLC

Doing Business As: DR DAVID CHISHOLM

Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 02D1021693

Address:
500 E SWANSON AVE
STE 3
WASILLA, AK
ZIP 99654
Phone: (907) 357-6180
Get Directions

CAMELOT FAMILY HEALTH LLC is a family medicine in Wasilla, AK. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. CAMELOT FAMILY HEALTH LLC NPI is 1336685908. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Dr David Chisholm.

The provider's business location address is:

500 E SWANSON AVE
STE 3
WASILLA, AK
ZIP 99654-197
Phone: (907) 357-6180
Fax: (907) 357-6184

The provider's authorized official is David R Chisholm .
The authorized official title is Owner and has the following contact phone number (907) 357-6180.

The CLIA number assigned to this NPI record is 02D1021693 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 1/6/2017 and was last updated on 1/6/2017.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207Q00000XFamily MedicineYes
2208VP0000XPain MedicinePain MedicineNo

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11009915MEDICAIDALASKA

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

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