Healthcare Provider Details

I. General information

NPI: 1770244568
Provider Name (Legal Business Name): EXPRESS CARE AK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W NORTHERN LIGHTS BLVD STE B
ANCHORAGE AK
99503-3652
US

IV. Provider business mailing address

PO BOX 5608
PORTLAND OR
97228-5608
US

V. Phone/Fax

Practice location:
  • Phone: 907-212-5165
  • Fax:
Mailing address:
  • Phone: 888-227-3312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DONALD WAYNE ANDERSON JR.
Title or Position: ASSISTANT SECRETARY OF ENROLLMENTS
Credential:
Phone: 425-358-9786