| Atlas Medical Aco Llc | |
|
3831 E Blue Lupine Dr Ste C Wasilla AK 99654-8461 | |
| (907) 521-2368 | |
| Not Available |
| Full Name | Atlas Medical Aco Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3831 E Blue Lupine Dr Ste C, Wasilla, Alaska |
| Authorized Official Name and Position | Gregory Chad Mangum (OWNER) |
| Authorized Official Contact | 4355145646 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Atlas Medical Aco Llc Po Box 4682 Logan UT 84323-4682 Ph: () - | Atlas Medical Aco Llc 3831 E Blue Lupine Dr Ste C Wasilla AK 99654-8461 Ph: (907) 521-2368 |
| NPI Number | 1629807086 |
|---|---|
| Provider Enumeration Date | 08/01/2024 |
| Last Update Date | 10/17/2024 |
| Medicare PECOS PAC ID | 1456885227 |
|---|---|
| Medicare Enrollment ID | O20241218000012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629807086 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Nathan Neves George |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134638141 PECOS PAC ID: 3375809387 Enrollment ID: I20171108000339 |
| Provider Name | Rachel Elizabeth Rekow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659996049 PECOS PAC ID: 6103243712 Enrollment ID: I20200819001486 |
| Provider Name | Timothy J Buffey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164422663 PECOS PAC ID: 2860456191 Enrollment ID: I20211206001817 |
| Provider Name | Laura Jean-francois |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114253978 PECOS PAC ID: 0547302382 Enrollment ID: I20220222000228 |
| Provider Name | Candice Renee Faria |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184094930 PECOS PAC ID: 0840592770 Enrollment ID: I20220517002504 |
| Provider Name | Brandie Banks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588286850 PECOS PAC ID: 8527466721 Enrollment ID: I20220728002190 |
| Provider Name | Michelle Leiolani Vanderpool |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477224426 PECOS PAC ID: 7012362775 Enrollment ID: I20231016002475 |
| Provider Name | Shane Willis Mozingo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295347474 PECOS PAC ID: 5991157505 Enrollment ID: I20240119000787 |
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