MEDICARE: JOSE PRIMO N ANZILOTTI

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1982721981
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSE PRIMO N ANZILOTTI

Provider Business Mailing Address
First Line	:	PO BOX 241769
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99524-1769
Country	:	US
Telephone Number	:	907-770-2301
Fax Number	:	907-770-2325

Provider Business Practice Location Address
First Line	:	MILE 69.1 PARKS HIGHWAY
Second Line	:
City	:	WILLOW
State	:	AK
Zip	:	99688-0349
Country	:	US
Telephone Number	:	907-495-4362
Fax Number	:	907-495-4363

Authorized Official
Title or Position	:	BILLING AGENT
Name	:	JOSEPH E BEATY
Credential	:
Telephone Number	:	907-770-2301

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	08/22/2020

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