Provider Demographics
NPI:1316489354
Name:IDEAL FAMILY MEDICINE
Entity type:Organization
Organization Name:IDEAL FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BABEE ANGELYNNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:907-746-3366
Mailing Address - Street 1:440 W EVERGREEN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6984
Mailing Address - Country:US
Mailing Address - Phone:907-746-3366
Mailing Address - Fax:
Practice Address - Street 1:440 W EVERGREEN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6984
Practice Address - Country:US
Practice Address - Phone:907-746-3366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-08
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center