Healthcare Provider Details

I. General information

NPI: 1962100727
Provider Name (Legal Business Name): PURE HEALTHCARE OF ALASKA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 LAKE OTIS PKWY STE 301
ANCHORAGE AK
99508-5226
US

IV. Provider business mailing address

4179 S RIVERBOAT RD STE 220
TAYLORSVILLE UT
84123-2986
US

V. Phone/Fax

Practice location:
  • Phone: 907-318-9300
  • Fax: 907-416-6961
Mailing address:
  • Phone: 801-590-9267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA T TANDY
Title or Position: DIRECTOR
Credential:
Phone: 801-590-9267