MEDICARE: ALASKA MEDICAL SERVICES 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	363A00000X	Physician Assistant	882	AK

General Provider Information

NPI Number	:	1972977866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALASKA MEDICAL SERVICES INC.

Provider Business Mailing Address
First Line	:	2240 PAXSON DR UNIT 1
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99504-3412
Country	:	US
Telephone Number	:	907-280-9787
Fax Number	:	888-308-8916

Provider Business Practice Location Address
First Line	:	2240 PAXSON DR UNIT 1
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99504-3412
Country	:	US
Telephone Number	:	907-280-9787
Fax Number	:	888-308-8916

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GREGORY SCOTT HACKENBRUCH
Credential	:	PA-C
Telephone Number	:	907-903-4844

Provider Enumeration Date	:	11/16/2015
Last Update Date	:	11/16/2015

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Directions to “ALASKA MEDICAL SERVICES INC. ” Practice Location

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