MEDICARE: HEALTH WORKS FAMILY MEDICAL CLINIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679772735
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH WORKS FAMILY MEDICAL CLINIC INC

Provider Business Mailing Address
First Line	:	12812 OLD GLENN HWY SUITE A7
Second Line	:
City	:	EAGLE RIVER
State	:	AK
Zip	:	99577-7558
Country	:	US
Telephone Number	:	907-770-2301
Fax Number	:	907-770-2325

Provider Business Practice Location Address
First Line	:	12812 OLD GLENN HWY STE A7
Second Line	:
City	:	EAGLE RIVER
State	:	AK
Zip	:	99577-7003
Country	:	US
Telephone Number	:	907-622-9675
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARY ANN EGBERT
Credential	:	A.N.P.
Telephone Number	:	907-622-9675

Provider Enumeration Date	:	07/17/2007
Last Update Date	:	04/21/2011

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