Healthcare Provider Details

I. General information

NPI: 1316280209
Provider Name (Legal Business Name): RBS EVOLUTION OF ALASKA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2013
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 HOSPITAL PL
SOLDOTNA AK
99669-7559
US

IV. Provider business mailing address

1044 JACKSON FELTS RD
JOELTON TN
37080-4839
US

V. Phone/Fax

Practice location:
  • Phone: 907-222-7762
  • Fax: 907-222-7764
Mailing address:
  • Phone: 615-746-4711
  • Fax: 615-296-0952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2278P1004X
TaxonomyPulmonary Diagnostics Certified Respiratory Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL MOORE
Title or Position: ADMINISTRATOR
Credential:
Phone: 615-746-4711