| Pivotal Care Partnership LLC | |
|
2925 Debarr Rd Ste 199 Anchorage AK 99508-2959 | |
| (907) 632-5057 | |
| Not Available |
| Full Name | Pivotal Care Partnership LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 2925 Debarr Rd Ste 199, Anchorage, Alaska |
| Authorized Official Name and Position | Bruce Havelock (DIRECTOR) |
| Authorized Official Contact | 9073752025 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pivotal Care Partnership LLC Po Box 90812 Anchorage AK 99509-0812 Ph: (907) 375-2025 | Pivotal Care Partnership LLC 2925 Debarr Rd Ste 199 Anchorage AK 99508-2959 Ph: (907) 632-5057 |
| NPI Number | 1811596026 |
|---|---|
| Provider Enumeration Date | 10/19/2020 |
| Last Update Date | 12/30/2020 |
| Certification Date | 12/30/2020 |
| Medicare PECOS PAC ID | 2264966779 |
|---|---|
| Medicare Enrollment ID | O20241106002376 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811596026 | NPI | - | NPPES |
| 1588968945 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (NU) | Primary |
| Provider Name | Je'dette Angelique Green |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588968945 PECOS PAC ID: 4486823564 Enrollment ID: I20110805000457 |
| Provider Name | Adrienne Jane Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235575788 PECOS PAC ID: 6204078769 Enrollment ID: I20130813000179 |
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