Provider Demographics
NPI:1396140950
Name:ALASKA PEDIATRIC SPECIALTIES LLC
Entity type:Organization
Organization Name:ALASKA PEDIATRIC SPECIALTIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:ROATEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-717-9871
Mailing Address - Street 1:4100 LAKE OTIS PKWY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5229
Mailing Address - Country:US
Mailing Address - Phone:907-929-7337
Mailing Address - Fax:907-929-7330
Practice Address - Street 1:4100 LAKE OTIS PKWY
Practice Address - Street 2:SUITE 206
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5229
Practice Address - Country:US
Practice Address - Phone:907-929-7337
Practice Address - Fax:907-929-7330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-24
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty