Provider Demographics
NPI:1194903211
Name:ALASKA LASER SERVICES, LLC
Entity type:Organization
Organization Name:ALASKA LASER SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-547-4130
Mailing Address - Street 1:6339 E SPEEDWAY BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-1147
Mailing Address - Country:US
Mailing Address - Phone:520-323-8732
Mailing Address - Fax:520-258-0304
Practice Address - Street 1:35555 SPUR HWY
Practice Address - Street 2:PMB 360
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7625
Practice Address - Country:US
Practice Address - Phone:520-323-8732
Practice Address - Fax:520-258-0304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical