Provider Demographics
NPI:1306975412
Name:AK FITNESS HEALTH CENTER INC.
Entity type:Organization
Organization Name:AK FITNESS HEALTH CENTER INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:H
Authorized Official - Last Name:ANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:903-663-6332
Mailing Address - Street 1:2903 JUDSON RD
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-1803
Mailing Address - Country:US
Mailing Address - Phone:903-663-8845
Mailing Address - Fax:903-663-6347
Practice Address - Street 1:2903 JUDSON RD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-1803
Practice Address - Country:US
Practice Address - Phone:903-663-8848
Practice Address - Fax:903-663-6347
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A K FITNESS HEALTH CENTER INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-05
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4739040001Medicare ID - Type Unspecified
TX1548342504Medicare PIN