Provider Demographics
NPI:1336532274
Name:TOWER JOINT REPLACEMENT CLINIC
Entity type:Organization
Organization Name:TOWER JOINT REPLACEMENT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VERONICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-222-2924
Mailing Address - Street 1:2401 E 42ND AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5228
Mailing Address - Country:US
Mailing Address - Phone:907-222-2924
Mailing Address - Fax:907-222-2934
Practice Address - Street 1:2401 E 42ND AVE STE 101
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5228
Practice Address - Country:US
Practice Address - Phone:907-222-2924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-17
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKS3012207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1631591Medicaid
AKMD30121Medicaid
AK1631591Medicaid
AK166613Medicare UPIN