| A4 Specialty Medical Group Llc | |
|
510 W Tudor Rd Ste 1 Anchorage AK 99503-6649 | |
| (907) 223-7347 | |
| Not Available |
| Full Name | A4 Specialty Medical Group Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 510 W Tudor Rd Ste 1, Anchorage, Alaska |
| Authorized Official Name and Position | Lisa Bruce (CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 9072237347 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| A4 Specialty Medical Group Llc 510 W Tudor Rd Ste 1 Anchorage AK 99503-6649 Ph: (907) 223-7347 | A4 Specialty Medical Group Llc 510 W Tudor Rd Ste 1 Anchorage AK 99503-6649 Ph: (907) 223-7347 |
| NPI Number | 1659010361 |
|---|---|
| Provider Enumeration Date | 06/01/2022 |
| Last Update Date | 06/01/2022 |
| Medicare PECOS PAC ID | 7315313558 |
|---|---|
| Medicare Enrollment ID | O20221013000870 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659010361 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Jeffrey G Demain |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1548201395 PECOS PAC ID: 7810989399 Enrollment ID: I20040706000728 |
| Provider Name | Melissa Van Fossen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235837865 PECOS PAC ID: 6204291792 Enrollment ID: I20230505002290 |
| Provider Name | Cielito Marie Bundang Bowen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437921095 PECOS PAC ID: 9638528060 Enrollment ID: I20231212000051 |
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