Provider Demographics
NPI:1215272620
Name:GLACIER MANAGEMENT SERVICES LLC
Entity type:Organization
Organization Name:GLACIER MANAGEMENT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEFANO
Authorized Official - Middle Name:
Authorized Official - Last Name:EMILI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-770-7213
Mailing Address - Street 1:3260 PROVIDENCE DR STE 528
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4608
Mailing Address - Country:US
Mailing Address - Phone:907-770-7213
Mailing Address - Fax:907-770-7214
Practice Address - Street 1:3260 PROVIDENCE DR STE 528
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4608
Practice Address - Country:US
Practice Address - Phone:907-770-7213
Practice Address - Fax:907-770-7214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5824207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty