Healthcare Provider Details

I. General information

NPI: 1407171069
Provider Name (Legal Business Name): NORTHERN ANESTHESIA AND PAIN MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10928 EAGLE RIVER RD SUITE 240
EAGLE RIVER AK
99577-8078
US

IV. Provider business mailing address

10928 EAGLE RIVER RD SUITE 240
EAGLE RIVER AK
99577-8078
US

V. Phone/Fax

Practice location:
  • Phone: 907-622-7246
  • Fax: 907-622-7247
Mailing address:
  • Phone: 907-622-7246
  • Fax: 907-622-7247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number940734
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number940734
License Number StateAK

VIII. Authorized Official

Name: DR. HEATH MCANALLY
Title or Position: MANAGER
Credential: M.D.
Phone: 907-622-7246