Provider Demographics
NPI:1104517192
Name:ALYESKA TRAUMA & ACUTE GENERAL SURGERY LLC
Entity type:Organization
Organization Name:ALYESKA TRAUMA & ACUTE GENERAL SURGERY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CINDERELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLLEFSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-865-5252
Mailing Address - Street 1:PO BOX 220774
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99522-0774
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4001 LAUREL ST STE 205
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5300
Practice Address - Country:US
Practice Address - Phone:907-562-8346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-19
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Multi-Specialty