Healthcare Provider Details

I. General information

NPI: 1275307449
Provider Name (Legal Business Name): TRAILHEAD MEDICAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 NORTHWAY DR
ANCHORAGE AK
99508-2030
US

IV. Provider business mailing address

729 NORTHWAY DR
ANCHORAGE AK
99508-2030
US

V. Phone/Fax

Practice location:
  • Phone: 907-644-3239
  • Fax: 907-644-3983
Mailing address:
  • Phone: 907-644-3239
  • Fax: 907-644-3983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY JEANETTE ELL
Title or Position: OWNER/MEMBER
Credential: FNP-C
Phone: 303-990-1432