Healthcare Provider Details

I. General information

NPI: 1962973271
Provider Name (Legal Business Name): ALASKA CENTER FOR PAIN RELIEF INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2018
Last Update Date: 12/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 N SEWARD MERIDIAN PKWY STE 104
WASILLA AK
99654-7241
US

IV. Provider business mailing address

865 N SEWARD MERIDIAN PKWY STE 104
WASILLA AK
99654-7241
US

V. Phone/Fax

Practice location:
  • Phone: 907-357-2277
  • Fax: 907-339-4801
Mailing address:
  • Phone: 907-357-2277
  • Fax: 907-339-4801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1627577
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer

VIII. Authorized Official

Name: DR. CHRISTOPHER M. GAY
Title or Position: PRESIDENT
Credential: MD
Phone: 907-339-4800