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NPI Code Detail

MEDICARE: HILLSIDE FAMILY MEDICINE, LLC

MEDICARE: HILLSIDE FAMILY MEDICINE, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician309063AK

General Provider Information

NPI Number : 1417120965
Entity Type Code : Organization
Provider Name (Legal Business Name) : HILLSIDE FAMILY MEDICINE, LLC
Provider Business Mailing Address
First Line : 9220 LAKE OTIS PKWY STE 9
Second Line :
City : ANCHORAGE
State : AK
Zip : 99507-4249
Country : US
Telephone Number : 907-344-0200
Fax Number : 907-344-0214
Provider Business Practice Location Address
First Line : 9220 LAKE OTIS PKWY STE 9
Second Line :
City : ANCHORAGE
State : AK
Zip : 99507-4249
Country : US
Telephone Number : 907-344-0200
Fax Number : 907-344-0214
Authorized Official
Title or Position : OWNER
Name : DR. JOHN NOLTE
Credential : M.D.
Telephone Number : 907-344-0200
Provider Enumeration Date : 04/04/2008
Last Update Date : 04/04/2008

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Directions to “HILLSIDE FAMILY MEDICINE, LLC ” Practice Location

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