MEDICARE: HEALTH WORKS FAMILY MED CLINIC INC.

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
1	363L00000X	Nurse Practitioner	580	AK

General Provider Information

NPI Number	:	1679571640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH WORKS FAMILY MED CLINIC INC.

Provider Business Mailing Address
First Line	:	12812 OLD GLENN HWY
Second Line	:
City	:	EAGLE RIVER
State	:	AK
Zip	:	99577-7003
Country	:	US
Telephone Number	:	907-622-9675
Fax Number	:	907-622-9676

Provider Business Practice Location Address
First Line	:	12812 OLD GLENN HWY
Second Line	:
City	:	EAGLE RIVER
State	:	AK
Zip	:	99577-7003
Country	:	US
Telephone Number	:	907-622-9675
Fax Number	:	907-622-9676

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. MARY ANN EGBERT
Credential	:	ADVANCED NP
Telephone Number	:	907-622-9675

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	08/22/2020

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