Healthcare Provider Details

I. General information

NPI: 1588805048
Provider Name (Legal Business Name): HEALTH NORTH FAMILY MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2009
Last Update Date: 04/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34924 STERLING HIGHWAY BUILDING B
STERLING AK
99672
US

IV. Provider business mailing address

34924 STERLING HIGHWAY BUILDING B
STERLING AK
99672
US

V. Phone/Fax

Practice location:
  • Phone: 907-260-7729
  • Fax:
Mailing address:
  • Phone: 907-260-7729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number927322
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number4349AK
License Number StateAK

VIII. Authorized Official

Name: DR. ROD A HALL
Title or Position: PRESIDENT
Credential: D.O.
Phone: 907-260-7729