Healthcare Provider Details

I. General information

NPI: 1104517192
Provider Name (Legal Business Name): ALYESKA TRAUMA & ACUTE GENERAL SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2023
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 LAUREL ST STE 205
ANCHORAGE AK
99508-5300
US

IV. Provider business mailing address

PO BOX 220774
ANCHORAGE AK
99522-0774
US

V. Phone/Fax

Practice location:
  • Phone: 907-562-8346
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CINDERELLA TOLLEFSEN
Title or Position: CEO
Credential:
Phone: 907-865-5252