Provider Demographics
NPI:1497825897
Name:ALASKA CLINIC LLC
Entity type:Organization
Organization Name:ALASKA CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ISMET
Authorized Official - Middle Name:BIL
Authorized Official - Last Name:KURSUNOGLU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-357-7240
Mailing Address - Street 1:3750 E COUNTRY FIELD CIR STE B
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6659
Mailing Address - Country:US
Mailing Address - Phone:907-357-7240
Mailing Address - Fax:907-357-7241
Practice Address - Street 1:3750 E COUNTRY FIELD CIR STE B
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6659
Practice Address - Country:US
Practice Address - Phone:907-357-7240
Practice Address - Fax:907-357-7241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5410261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty