Provider Demographics
NPI:1588915755
Name:ALASKA PEDIATRICS ASSOCIATES PC
Entity type:Organization
Organization Name:ALASKA PEDIATRICS ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWELL-CANADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-357-5437
Mailing Address - Street 1:5050 E DUNBAR DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7758
Mailing Address - Country:US
Mailing Address - Phone:907-357-5437
Mailing Address - Fax:907-357-1854
Practice Address - Street 1:5050 E DUNBAR DR
Practice Address - Street 2:SUITE F
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7758
Practice Address - Country:US
Practice Address - Phone:907-357-5437
Practice Address - Fax:907-357-1854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5749208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD5506Medicaid