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FULL SPECTRUM HEALTH LLC NPI 1407360977


NPI Information

NPI: 1407360977
Provider Name: FULL SPECTRUM HEALTH, LLC
Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

CLIA Number: 02D2149353

Address:
307 E NORTHERN LIGHTS BLVD STE 201
ANCHORAGE, AK
ZIP 99503
Phone: (907) 229-9766
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FULL SPECTRUM HEALTH, LLC is a multi-specialty clinic center in Anchorage, AK. FULL SPECTRUM HEALTH, LLC NPI is 1407360977. The provider is registered as an organization entity type.

The provider's business location address is:

307 E NORTHERN LIGHTS BLVD STE 201
ANCHORAGE, AK
ZIP 99503-701
Phone: (907) 229-9766
Fax: (888) 974-0807

The provider's authorized official is Tracey Wiese .
The authorized official title is Owner and has the following contact phone number (907) 727-4239.

The CLIA number assigned to this NPI record is 02D2149353 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/20/2017 and was last updated on 11/20/2017.


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
1261QM1300XClinic/CenterMulti-SpecialtyYes

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
11022312MEDICAIDALASKA

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

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.