Provider Demographics
NPI:1154591451
Name:LA INTEGRATIVE PRIMARY CARE CENTRE INC
Entity type:Organization
Organization Name:LA INTEGRATIVE PRIMARY CARE CENTRE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-344-7722
Mailing Address - Street 1:8811 TOLOFF ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-3848
Mailing Address - Country:US
Mailing Address - Phone:907-346-7722
Mailing Address - Fax:907-346-7726
Practice Address - Street 1:8811 TOLOFF ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-3848
Practice Address - Country:US
Practice Address - Phone:907-346-7722
Practice Address - Fax:907-346-7722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK911398261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty