Provider Demographics
NPI:1538789300
Name:ALASKA SHOULDER AND ORTHOPAEDIC INSTITUTE
Entity type:Organization
Organization Name:ALASKA SHOULDER AND ORTHOPAEDIC INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAISLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-591-3636
Mailing Address - Street 1:PO BOX 112069
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99511-2069
Mailing Address - Country:US
Mailing Address - Phone:907-646-7846
Mailing Address - Fax:907-646-7847
Practice Address - Street 1:2741 DEBARR RD STE C408
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2980
Practice Address - Country:US
Practice Address - Phone:907-646-7846
Practice Address - Fax:907-312-7137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-22
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty